In-Office Needle Arthroscopy for Superior Labral Tear Debridement.

SLAP tears are a common cause of shoulder pain in overhead athletes. The benefits of in-office nano-arthroscopy include the ability to diagnosis and treat biceps tendinopathy, quicker patient recovery, reduced health care costs, and improved patient satisfaction. This technique can be particularly advantageous in the management of SLAP tears given that magnetic resonance imaging has poor sensitivity without the use of an invasive arthrogram. The purpose of this technical report is to describe our technique for performing in-office nano-arthroscopy for SLAP tears with special consideration of the technique for obtaining adequate local anesthesia, proper indications, and adequate visualization, as well as the advantages of performing these procedures in the office rather than the operating room.

Paresthesia Is Predictive of Symptom Recurrence After Fasciotomy for Exertional Compartment Syndrome of the Leg.

BACKGROUND: Exertional compartment syndrome (ECS) is an underdiagnosed cause of lower extremity pain among athletes. The condition can be managed operatively by fasciotomy to relieve excess compartment pressure. However, symptom recurrence rates after fasciotomy are considerable, ranging from 3% to 17%. HYPOTHESIS: Leg paresthesia and its distribution during ECS episodes would be a significant predictor of outcomes after fasciotomy. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 4. METHODS: We conducted a retrospective chart review of patients who underwent fasciotomy for ECS at our center from 2010 to 2020 (institutional review board no. 21-00107). We measured postoperative outcomes including pain frequency and severity, Tegner activity level, and return to sport. Significant predictors of outcomes were identified using multivariable linear and logistic regression. P values <0.05 were considered significant. RESULTS: A total of 78 legs (from 42 male and 36 female participants) were included in the study with average follow-up of 52 months (range, 3-126 months); 33 participants (42.3%) presented with paresthesia. Paresthesia was an independent predictor of worse outcomes, including more severe pain at rest (P = 0.05) and with daily activity (P = 0.04), reduced postoperative improvement in Tegner scores (P = 0.04), and lower odds of return to sport (P = 0.05). Those with paresthesia symptoms in the tibial nerve distribution had worse outcomes than those without paresthesia in terms of preoperative-to-present improvement in pain frequency (P < 0.01), pain severity at rest (P < 0.01) and with daily activity (P = 0.04), and return to sport (P = 0.04). CONCLUSION: ECS patients who present with paresthesia have worse pain and activity outcomes after first-time fasciotomy, but prognosis is worst among those with tibial nerve paresthesia. CLINICAL RELEVANCE: Paresthesia among ECS patients is broadly predictive of more severe recurrent leg pain, reduced activity level, and decreased odds of return to sport after fasciotomy.

In-Office Needle Arthroscopy of the Knee With Lateral Parapatellar Retinacular Release.

The lateral patellofemoral joint, composed of multiple soft-tissue structures, balances the knee by aiding patella tracking, stability, and force distribution. Arthroscopic lateral release is a well-described procedure that addresses patellofemoral knee pain and, in cases with patellar instability, may be combined with medial stabilization. In-office needle arthroscopy is an up-trending technique that simultaneously diagnoses and treats patellofemoral pathology in the office, leading to a quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this Technical Note is to describe in-office needle arthroscopy technique to address patellofemoral pain and lateral patellar mal-tracking, with special consideration for achieving adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.

In-Office Needle Arthroscopy with Meniscal Repair for Meniscal Lesions of the Knee.

Meniscal injuries are a common cause of knee pain and are often an indication for knee arthroscopy, the most common orthopedic surgical procedure in the United States. In-office needle arthroscopy (IONA) is a described technique with the ability to diagnose and treat meniscal injuries in the office. IONA allows for diagnosis and treatment at a significantly deceased cost, with both quicker patient recovery, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing in-office needle arthroscopy for meniscal injuries of the knee, including the technique for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.

Reproducible and Effective Biceps Tenodesis Method Utilizing In-Office Nano-Arthroscopy.

Biceps tendinopathy is a common cause of chronic anterior shoulder pain characterized by altered joint mechanics with considerable deficits in range of motion secondary to pain. The benefits of in-office nano-arthroscopy (IONA) include the ability to diagnosis and treat biceps tendinopathy, quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing IONA for biceps tendinopathy (biceps tenotomy/biceps tenodesis), with special consideration for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.

In-Office Needle Arthroscopy With Cartilage Allograft Extracellular Matrix Application for Cartilage Lesions of the Knee.

Chondral and osteochondral lesions of the knee are a common cause of pain, mechanical symptoms, and swelling for patients. The benefits of in-office needle arthroscopy (IONA) include the ability to diagnose and treat chondral or osteochondral lesions in the office, quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this technical note is to describe the technique for performing in-office needle arthroscopy for chondral or osteochondral contained lesions of the knee, with special consideration of the technique for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.

In-Office Nano-Arthroscopy of the Shoulder with Acromioplasty.

Subacromial decompression with acromioplasty is among the most commonly performed shoulder procedures. The advantages of in-office nano-arthroscopy include the capability of diagnosing and treating subacromial impingement, swifter patient recovery, improved cost-effectiveness, and superior patient satisfaction. The purpose of this technical report is to describe our technique for performing in-office nano-arthroscopy for subacromial decompression (subacromial bursectomy and acromioplasty), with a particular focus on appropriate indications, providing sufficient local anesthesia, optimizing visualization, and discussing the advantages of the in-office setting compared to the operating room.

Age-Associated Functional Outcomes Following Hip Arthroscopy in Females Analysis with 5-Year Follow-Up.

PURPOSE: The purpose of this study was to evaluate out- comes of hip arthroscopy for femoroacetabular impingement (FAI) in female patients at 5-year follow-up. The working hypothesis for this study was that increased age and body mass index (BMI) would be associated with poor outcomes. METHODS: This study included all female patients 14 years and older who underwent primary hip arthroscopy for FAI with 5-year patient-reported outcome scores. Patients were separated into three age-based cohorts (< 30 years old, 30 to 45 years old, and > 45 years old) for subsequent statistical analysis. This analysis included a comparison of patient demographic information, intraoperative pathology, and functional outcome scores (modified Harris Hip Score [mHHS] and nonarthritic hip score [NAHS]). Statistically significant values were utilized in a regression-based analy- sis to determine predictors of 5-year outcomes in female patients. A p-value of < 0.05 was considered to be statisti- cally significant. RESULTS: Overall, 97 patients met the inclusion criteria, and there was no significant difference in patient demo- graphics (other than age and BMI) or in intraoperative pathologies identified. There were no significant difference across the three groups for mHHS and NAHS at baseline (p > 0.05). At baseline, there were no statistically significant differences between groups for NAHS scores, however < 30-year-old and 30- to 45-year-old cohorts had superior final NAHS scores relative to the > 45-year-old cohort (p = 0.005). At 5-year follow-up, the NAHS scores were significantly better for patients under 30 and 30 to 45 year olds relative to patients over 45 (84.2 ± 15.1 vs. 86.7 ± 11.0 vs. 71.9 ± 26.8, respectively; p = 0.005). Overall, 88 patients (91%) met the minimal clinically important differ- ence (MCID), and 60 patients (62%) achieved the patient acceptable symptomatic state (PASS). Baseline mHHS and BMI were shown to be statistically significant predictors of achieving MCID at 5 years in multivariate analysis (p < 0.001). CONCLUSION: The results of this study suggest that women generally have good-to-excellent outcomes following hip ar- throscopy, although females older than 45 may have inferior outcomes relative to younger patients, and BMI and baseline mHHS may be utilized to predict long-term improvement.

Role of MicroRNA-141 in the Aging Musculoskeletal System: A Current Overview.

MicroRNA's are small non-coding RNAs that regulate the expression of genes by targeting the 3' UTR's of mRNA. Studies reveal that miRNAs play a pivotal role in normal musculoskeletal function such as mesenchymal stem cell differentiation, survivability and apoptosis, osteogenesis, and chondrogenesis. Changes in normal miRNA expression have been linked to a number of pathological disease processes. Additionally, with aging, it is noted that there is dysregulation in the normal function of stem cell differentiation, bone formation/degradation, chondrocyte function, and muscle degeneration. Due to the change in expression of miRNA in degenerative musculoskeletal pathology, it is believed that these molecules may be at least partially responsible for cellular dysfunction. A number of miRNAs have already been identified to play a role in osteoarthritis, osteoporosis and sarcopenia. One miRNA that has become of interest recently is miRNA 141. The purpose of this article is to review the current literature available on miRNA 141 and how it could play a role in osteoporosis, osteoarthritis and musculoskeletal pathology overall.