Outcomes of arthroscopic coracoclavicular management for acromioclavicular joint injuries: A systematic review.

Introduction: Various surgical procedures for coracoclavicular (CC) ligament repair have been described for symptomatic acromioclavicular joint dislocations, with none emerging as a clear gold standard. There has been increased interest in arthroscopic approaches. This systematic review evaluates clinical outcomes after arthroscopic surgeries used to treat chronic and acute AC joint dislocations. Methods: We searched three databases (PubMed, EMBASE, and OVID [MEDLINE]) from database inception to December 20, 2022. Studies were included if they met the following criteria: studies evaluating humans, English language studies, level of evidence I to IV, and studies investigating clinical outcomes in patients following arthroscopic surgery for coracoclavicular ligament reconstruction. Studies on open reconstruction techniques only were excluded. Primary outcomes included function/pain scores, coracoclavicular distances, complications, and revision rates. Results: Fifty-two studies were included. In 33 studies, postoperative Constant-Murley scores ranged from 82.8 to 99 points. Postoperative VAS scores ranged from 0.3 to 4.1 in 16 studies. In 46 studies, revision rates ranged from 0 % to 44.4 %. We did not observe a difference in revision rates between chronic and acute cases (P = 0.268). Complications were more common in chronic than acute cases (25.5 % vs. 16.4 %; P < 0.001). Conclusions: Arthroscopic surgery for chronic and acute CC ligament injuries exceeds the MCID and PASS for several outcomes, with low failure rates. Arthroscopic CC reconstruction is a safe and effective alternative for chronic AC joint dislocations. Level of evidence: IV (Systematic Review of Level I-IV Studies).

Efficacy of Outside-In Hip Arthroscopy without Traction in the Treatment of Hip Synovial Osteochondromatosis.

Arthroscopic treatments of hip synovial osteochondromatosis are mostly performed under traction, resulting in neurovascular injury or iatrogenic damage to the labrum or cartilage. This study aimed to assess the effectiveness of outside-in hip arthroscopy without traction in treating hip synovial osteochondromatosis. This retrospective study was conducted on a series of patients with hip synovial osteochondromatosis treated using outside-in hip arthroscopy without traction in our hospital between 2018 and 2020. Plain radiography and magnetic resonance imaging (MRI) scans were obtained. The Harris hip score (HHS), hip range of motion (ROM), and visual analog scale (VAS) scores were analyzed. The preoperative scores and last follow-up scores were compared with a paired-sample t test. The complications and recurrence postsurgery were recorded. This study included five patients (three male and two female) with an average age of 41 years (range 28-54 years). The mean follow-up time was 25.2 months (range 18-36 months). All patients experienced groin pain relief and improved ROM. The mean VAS score was significantly lower postoperatively (0.4 ± 0.5) than preoperatively (3.2 ± 0.8) (p < 0.001). The mean HHS improved from 58.6 ± 12.7 (range 43-73) to 89.8 ± 5.26 (range 81-95) (p < 0.001). No major complications, including infection, perineal numbness and swelling, neurotrosis, thromboembolism, or severe persistent pain, were reported. Synovial osteochondromatosis recurred in one patient after 2 years of follow-up without any obvious symptoms such as hip pain or joint locking. Therefore, no further treatment was necessary. This study showed that outside-in hip arthroscopy without traction might be a viable option for treating hip synovial osteochondromatosis, effectively and safely relieving symptoms with minimal complications, especially in patients without lesions in the central compartment.

Structural and Functional Alterations of the Deltoid Muscle After Arthroscopic Rotator Cuff Repair: A 2-Year Longitudinal Observation Study.

Background: Deltoid muscle detachment and atrophy have been reported to occur after shoulder surgery. Purpose: To investigate the 2-year changes in deltoid muscle structure and function after arthroscopic rotator cuff repair (ARCR) using magnetic resonance imaging (MRI) and electrophysical examination. Study Design: Case series; Level of evidence, 4. Methods: A total of 72 patients (72 shoulders) who underwent ARCR between 2015 and 2020 were enrolled. Whole deltoid muscle volume and regional (anterior, lateral, and posterior) muscle thicknesses were determined on T2-weighted MRI scans of both shoulders taken preoperatively and at 1, 3, 6, 12, and 24 months postoperatively, and their correlations with compound muscle action potentials (CMAPs), shoulder abduction muscle strength, and Constant scores were investigated. Comparison between groups was performed using paired or Student t tests, and the relationship between deltoid muscle volume and various factors was determined using Pearson correlation analysis. Results: The volume of the deltoid muscle on the affected side decreased from 44,369 ± 12,371 mm3 preoperatively to 38,139 ± 10,615 mm3 at 1 month postoperatively (P < .05), representing a 14% decrease. The deltoid muscle volume of the contralateral side also significantly decreased during the same time frame, from 43,278 ± 12,248 to 40,273 ± 11,464 mm3 (P < .05), representing a 7% decrease at 1 month postoperatively. Subsequently, the deltoid muscle volume on both sides recovered to preoperative levels at 12 months and was maintained at 24 months. Only the thickness of the anterior part of the deltoid was markedly decreased, from 13.9 ± 3.7 mm preoperatively to 12.0 ± 3.2 mm at 1 month postoperatively (P < .05), representing a 14% reduction. The CMAP amplitude showed a significant decrease at 1 month postoperatively; however, no significant difference was observed after 12 months when compared with the preoperative values or the values on the contralateral side. Positive correlations were found between deltoid muscle volume and CMAP amplitude at 24 months as well as between deltoid muscle volume and shoulder abduction muscle strength (R 2 = 0.698; P < .05) and Constant score (R 2 = 0.133; P < .05). Conclusion: Our study demonstrated that the early structural and functional decline of the deltoid muscle after ARCR was fully recovered within 1 year, confirming that this procedure does not negatively affect the deltoid muscle.

Shoulder Surgeries under Regional Anesthesia Approach and Outcome - A Case Series.

Introduction: Shoulder surgeries (arthroscopic or open) are usually performed under general anesthesia or combined with regional anesthesia. Post-operative pain following shoulder surgery is usually very severe and hinders early mobility of joints and recovery; which is also a cause of mental stress for the patient. Regional anesthetic techniques are known to provide excellent pain control postoperatively, both at rest and on movement. It allows faster recovery with earlier mobilization of joints. Profound knowledge of neural innervation of the shoulder is very essential to provide successful regional anesthesia for shoulder surgeries. Case Reports: We underwent a case series of 10 patients with multiple comorbidities and were categorized as high-risk patients, posted for shoulder surgeries under regional anesthesia (PNS-guided interscalene brachial plexus block combined with suprascapular nerve block). Five out of ten patients were of the ASA 3 category, with multiple comorbidities. Shoulder surgeries (arthroscopic/open) were planned under regional anesthesia with mild sedation and resulted in better surgeon and patient satisfaction perioperatively. Conclusion: Interscalene nerve block combined with suprascapular nerve block should be considered an alternative approach to general anesthesia for shoulder surgeries. Thus sole regional anesthesia can be considered a novel approach for all types of shoulder surgeries and is significantly safer for ASA Grade III and IV patients.

Postoperative Pathologies of the Hand Following Shoulder Surgery.

Purpose: Shoulder arthroscopy and arthroplasty are increasingly common procedures used to address shoulder pathologies. This study sought to evaluate the incidence of hand-related pathologies, including carpal tunnel syndrome (CTS), cubital tunnel syndrome (CuTS), trigger finger (TF), de Quervain tenosynovitis, and Dupuytren disease following shoulder arthroscopy and arthroplasty procedures. We hypothesized that patients undergoing shoulder surgery would have a higher incidence of hand-related pathologies within 1 year of surgery compared to controls. Methods: This was a retrospective analysis of 12,179 patients who underwent shoulder arthroscopy or arthroplasty surgery that were subsequently diagnosed with CTS, CuTS, TF, de Quervain tenosynovitis, or Dupuytren disease within 1 year after surgery. Relative risk of having associated hand pathologies following shoulder surgery was compared to controls. Results: In total, 10,285 patients underwent shoulder arthroscopy procedures during this period, of whom 815 (7.9%) had an associated hand pathology within 1 year from their shoulder procedure. Arthroscopic surgery was associated with an increased likelihood of having a hand pathology (RR 1.65, 95% CI 1.54-1.76), CTS (RR 1.57, 95% CI 1.42-1.73), CuTS (RR 2.25, 95% CI 1.94-2.61), TF (RR 1.76, 95% CI 1.53-2.03), and Dupuytren disease (RR 2.02, 95% CI 1.54-2.65), but was not associated with a higher likelihood of having de Quervain tenosynovitis. In total, 1,894 patients underwent shoulder arthroplasty procedures during this period, of whom 188 (9.9%) had an associated hand pathology within 1 year. Shoulder arthroplasty was associated with an increased likelihood of having a hand pathology (RR 2.04, 95% CI 1.78-2.34), CTS (RR 2.10, 95% CI 1.72-2.57), CuTS (RR 3.29, 95% CI 2.48-4.39), and TF (RR 1.99, 95% CI 1.47-2.70), but was not associated with an increased likelihood of having de Quervain tenosynovitis or Dupuytren disease. Conclusions: Shoulder arthroscopy and arthroplasty procedures were associated with an increased likelihood of having a CTS, CuTS, or a TF diagnosis made within 1 year of surgery. Only shoulder arthroscopy procedures were associated with a higher likelihood of having Dupuytren disease. Neither shoulder arthroscopy nor arthroplasty procedures were associated with an increased likelihood of a diagnosis of de Quervain tenosynovitis. These associations, however, do not necessarily imply causation, and further investigation is warranted to delineate this relationship. Type of study/level of evidence: Differential Diagnosis/Symptom Prevalence Study Level 3.

Effects of arthroscopic outside-in sutures versus all-inside sutures in the treatment of lateral disc meniscus injury of the knee joint under arthroscopy.

OBJECTIVE: To compare the clinical efficacy of arthroscopic outside-in suturing and all-inside suturing in the treatment of discoid lateral meniscus (DLM) injury, and to analyze the influencing factors for clinical efficacy. METHODS: We retrospectively selected 30 patients with DLM injury who received arthroscopic all-inside suturing at Wuzhou Workers' Hospital from January 2020 to December 2022 as the observation group. Another 30 patients who received arthroscopic outside-in suturing during the same period were enrolled as the control group. The surgical indicators, pre- and post-operative knee scores and proprioception difference of knee joint, postoperative complications and clinical efficacy were compared between the two groups. Factors affecting clinical efficacy of patients with DLM injury were identified using Logistic regression analysis. RESULTS: Significant differences were observed in operation time, hospital stay, blood loss and clinical efficacy between the two groups (all P<0.05); however, there was no significant difference in complications (P>0.05). The visual analog score (VAS) scores of both groups decreased over time at 1, 3, 5, 7, 15, and 30 days post-surgery, with the observation group scoring lower than the control group (all P<0.05). At 1, 3, and 6 months after the surgery, the international knee documentation committee (IKDC), Lysholm, and Tegner scores of both groups increased over time, with the observation group scoring higher than the control group (all P<0.05). Six months post-surgery, proprioception differences at 15°, 45°, and 75° of knee flexion were significantly decreased, with greater improvements observed in the observation group (P<0.05). Univariate analysis showed that operation time, IKDC and Lysholm scores at 6 months post-operation, postoperative complications, and suture method were factors influencing treatment outcomes in patients with DLM injury (all P<0.05). Multivariate Logistic regression analysis identified postoperative complications as an independent risk factor for poor treatment outcome in patients with DLM injury (P<0.05). CONCLUSION: Arthroscopic all-inside suturing for DLM injury offers significant clinical benefits, including shorter operation time and hospital stay, less blood loss, and improved knee joint function with fewer complications. Prolonged operation time, low IKDC and Lysholm scores at 6 months post-operation, postoperative complications and outside-in suturing technique are associated with poorer treatment outcomes in patients with DLM injury.

A Multicenter Analysis of 3 Decades of Hip Arthroscopy: Evolving Techniques and Growing Patient Volumes From 1988 to 2022.

Background: The number of hip arthroscopies performed in the United States has grown significantly over the past several decades, with evolving indications and emerging techniques. Purposes: To (1) examine the evolution of hip arthroscopy at 3 tertiary referral centers between 1988 and 2022 and (2) quantify trends in patient demographics and procedures performed. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed of all patients undergoing hip arthroscopy at 3 academic centers between 1988 and 2022. Demographic data were collected using standardized forms and operative notes, and intraoperative images were manually reviewed for each patient to determine the specific procedures performed at the time of the hip arthroscopy. Surgical procedures were plotted over time to evaluate trends. Patients were divided into 3 time periods for comparison: early hip arthroscopy from 1988 to 2008, 2009 (the time of the first labral repair in our cohort) to 2015, and 2016 to 2022. Results: A total of 3000 patients (age, 35.7 ± 13.8 years; age range, 10-89 years; female sex, 2109 (70.3%); body mass index, 27.4 ± 6.3 kg/m2) underwent arthroscopic hip procedures between 1988 and 2022. The mean number of cases increased from a mean of 3.2 per year in 1988-2008 to 285.9 per year in 2016-2022 (P < .001). Labral treatment at the time of primary hip arthroscopy evolved from 100% debridement and 0% repair in 1988-2008 to 5.0% debridement, 94.0% repair, and 1.0% labral reconstruction in 2016-2022 (P < .001). Cam resection increased from 4.1% in 1988-2008 to 86.9% in 2016-2022 (P < .001). By 2022, 45 out of 325 cases (13.8%) were revisions. The rate of capsular repair at the time of primary hip arthroscopy increased from 0.0% in 1988-2008 up to 81.0% in 2016-2022. Conclusion: There has been a significant growth of hip arthroscopy volumes as well as a significant transition from use as a tool for diagnosis and labral debridement to procedures restoring native anatomy including labral repair, cam resection, capsular repair, periacetabular osteotomy, and gluteal repair.

Determining the Patient Acceptable Symptom State (PASS) for Shoulder Strength After Subscapularis Arthroscopic Repair and Evaluating the Preoperative Predictors for PASS Achievement.

Background: Restoring shoulder strength after arthroscopic rotator cuff repair (ARCR) is critical, but there is limited understanding as to what patients consider satisfactory postoperative strength. Purpose: To determine the Patient Acceptable Symptom State (PASS) values for the Constant score strength parameter and internal rotation (IR) strength in patients who underwent ARCR for rotator cuff tears involving the subscapularis (SSC) muscle and evaluate for associations between preoperative and intraoperative patient characteristics with PASS achievement. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective analysis was conducted on prospectively collected data for 278 patients with an SSC tear (isolated or combined) who underwent ARCR and had minimum 2-year follow-up data. Functional outcomes (patient-reported outcomes, range of motion, Constant strength, and IR strength) were assessed preoperatively and at the latest follow-up. The overall, male, and female PASS values for postoperative strength measures were evaluated using receiver operating characteristic analysis. Correlation and logistic regression analyses were used to evaluate the relationship between preoperative variables and PASS achievement for Constant and IR strengths. Results: The mean follow-up time was 72.8 months. The overall, male, and female PASS values were 9.9 lb (4.5 kg), 14.5 lb (6.6 kg), and 8.5 lb (3.9 kg), respectively, for Constant strength and 15.2 lb (6.9 kg), 20.7 lb (9.4 kg), and 12.1 lb (5.5 kg), respectively, for IR strength. Older age, high fatty infiltration of the SSC tendon (Goutallier grades 3 and 4), and failure of SSC healing correlated negatively with PASS attainment for the strength measures. High fatty infiltration of the supraspinatus and infraspinatus muscles correlated negatively with Constant strength. Decreased coracohumeral distance (CHD) and larger SSC tears correlated negatively with achieving PASS for IR strength. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS. Conclusion: This study established the PASS values for Constant and IR strengths for patients after ARCR involving the SSC tendon. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.

Arthroscopic Reconstruction of an Anterior Cruciate Ligament Tear Using the Anatomic Single-Bundle Technique: A Clinical and Functional Outcome Evaluation.

BACKGROUND: The anterior cruciate ligament (ACL) consists of an anteromedial bundle and a posterolateral bundle giving anteroposterior and rotational stability to the knee. An ACL tear might lead to secondary changes in the knee joint if not operated in time. The aim of the study was to evaluate the clinical and functional results in patients with ACL tears treated by arthroscopic reconstruction using the anatomic single-bundle technique. METHODS: This was a prospective study conducted between June 2015 and December2017 at a teaching institute in Kolkata, India, on patients who underwent single-bundle arthroscopic reconstruction of an ACL tear. A minimum follow-up of nine months was considered for all patients. The functional outcome was assessed via the Lysholm knee score. RESULTS: A total of 45 patients were included in this study, of which 34 (75.56%) and eight (17.78%) patients showed excellent and good results, respectively, at the final follow-up. The mean age in this study was 29.88±9.02 years. No complication was seen in 95.6% of patients. The mean Lysholm score by the end of nine months was 95.31±6.55. At the time of the final follow-up, all the patients returned to their same activity status prior to injury. CONCLUSION: Arthroscopic anatomic single-bundle ACL reconstruction using hamstring autograft is an effective treatment modality for ACL injuries. It restores the stability of the knee and is associated with good recovery of joint function with an early return to active lifestyle and sports activities. This procedure achieves excellent clinical and functional outcomes without any long-term disability.

Arthroscopic shoulder surgery for gouty long head of biceps tendinitis: a case report.

OBJECTIVE: The objective of the case report is to analyze the clinical manifestations and imaging features of gouty long head of biceps tendinitis, and to summarize the methods and effects of shoulder arthroscopic surgery. CLINICAL PRESENTATION AND INTERVENTION: The clinical data of a 39-year-old Han Chinese female with gouty long head of the biceps tendinitis was retrospectively analyzed, and the clinical manifestations, imaging features, and diagnosis and treatment were analyzed. The patient presented with pain and limited movement of right shoulder joint. Computed tomography showed irregular high-density shadows above the glenoid and adjacent to the coracoid process of the right shoulder. Magnetic resonance imaging revealed superior labrum anterior and posterior injury with edema in the upper recess and axillary sac. After arthroscopic surgery, the "tofu residue" tissue of the long head of the biceps was removed, and the postoperative pathological examination proved that it was gout stone. CONCLUSION: Gouty long head of the biceps tendinitis is a rare disease. Arthroscopic surgery can probe the structural lesions of shoulder cavity in all aspects, improve the surgical accuracy, and reduce the trauma.

Fast rehabilitation does not worsen clinical, radiological, and arthroscopic outcomes after medial meniscus posterior root repair: A retrospective comparative study.

Background/Objective: The main surgical treatment for medial meniscus posterior root tear (MMPRT) has shifted from meniscectomy to meniscus repair; however, there is no clear consensus regarding the optimal postoperative management strategy after MMPRT repair. This study aimed to perform a comparative analysis of patients who received conventional rehabilitation or fast rehabilitation following MMPRT repair. Methods: The current retrospective cohort study compared clinical, radiological, and arthroscopic outcomes after conventional rehabilitation (group A, January 2020 to April 2020, 24 patients) with those after fast rehabilitation (group B, May 2020 to August 2020, 24 patients) in patients who underwent pullout repair for MMPRT. Partial weight-bearing and range of motion exercises were allowed 2 weeks postoperatively in group A and 1 week postoperatively in group B. In patients with an average weight of approximately 60 kg, full weight bearing was allowed 4 weeks postoperatively in group A and 3 weeks postoperatively in group B. Results: At 12 months postoperatively, the clinical scores, including International Knee Documentation Committee and Japanese Knee Injury and Osteoarthritis Outcome Score, significantly improved in both groups (p < 0.01). Although meniscus healing was achieved in both groups, medial meniscus extrusion significantly progressed by 0.9 mm in group A and 0.8 mm in group B (p < 0.01, compared with preoperative extrusion). There were no significant differences in clinical scores, arthroscopic meniscal healing status, or medial meniscus extrusion progression on magnetic resonance images between the groups. Conclusion: A fast rehabilitation protocol can be safely implemented without compromising patient outcomes after pullout repair for MMPRT.

Evaluation of the Suture Pull-Out Technique in Anterior Cruciate Ligament Avulsion Fractures at Different Weeks Post-fracture.

Background Anterior cruciate ligament (ACL) avulsion fractures often necessitate surgical intervention, with various fixation techniques available. Among these, the arthroscopic suture pull-out technique has gained attention as a promising approach. However, the influence of surgical timing on patient outcomes remains insufficiently studied. This study aims to evaluate the efficacy of the arthroscopic suture pull-out technique for ACL tibial avulsion fractures and assess how the timing of surgical intervention affects functional outcomes. Methodology This study was conducted at our hospital from November 2020 to October 2022. A total of 17 patients aged 21 to 41 years with isolated ACL avulsion fractures and no additional injuries or osteoarthritis were included. Participants were divided into three groups based on the interval from injury to surgery (one, two, or three weeks). The surgical procedure involved the suture pull-out technique. Postoperative management included immobilization, isometric exercises, and gradual weight-bearing. Functional outcomes were assessed using the Lysholm score, International Knee Documentation Committee (IKDC) score, Tegner Activity Scale, and Lachman test at 6, 10, and 14 months, along with radiological evaluations. Results Significant functional improvements were observed in all groups, with postoperative Lysholm, IKDC, and Tegner scores showing notable enhancements compared to preoperative values. No significant differences were found among the groups regarding the timing of surgery, indicating that delays within the first three weeks did not adversely impact outcomes. Most patients achieved a full range of motion. Two minor postoperative complications were reported, namely, one case of arthrofibrosis and one case of persistent laxity. Conclusions The arthroscopic suture pull-out technique is effective and reliable for ACL tibial avulsion fixation. The timing of surgery within the first three weeks does not significantly affect functional outcomes. Future research with larger sample sizes and longer follow-ups is recommended to further validate these findings and optimize surgical strategies.

Hip Arthroscopy Utilization Disparities and Complications Amongst Ethnic Groups.

While hip arthroscopy (HA) has increased in recent years, limited data exists regarding utilization and outcomes among racial groups. The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent HA from 2006 to 2017. Patients were stratified into 6 self-reported racial/ethnic categories: White, African American, Hispanic, Asian and Pacific Islander, Native American, and Unknown. Major and minor complications in the 30-day post-operative period were identified. Data were available for 2230 patients who underwent HA. There were significant differences in the proportions of HA procedures when examining by race. White patients comprised 69% of the patient sample, African American patients 5.6%, Hispanic patients 3.9%, Asian patients 2.5%, Native American patients 0.7% and Unknown race/ethnicity patients 18.3% (P < .05). HA utilization increased significantly over time by all groups but remained low among ethnic minorities compared to the White cohort. Overall, major, and minor 30-day complication rates were 1.3%, 0.5%, and 0.9%, respectively. Although African American and Hispanic patients had higher overall complication rates than White patients, the differences were not statistically significant. Surgeons should be aware of the underutilization of HA among racial/ethnic minorities, and further studies evaluating insurance status and access to care are needed.

Arthroscopic Trillat technique for chronic anterior shoulder instability: outcomes at 2 years follow-up in 74 at risk sport-patient.

BACKGROUND: Chronic anterior shoulder instability affects a young and athletic population, with a high demand for functional recovery and return to sport. Arthroscopic Trillat dynamic stabilization technique has shown great results at 2 years in terms of stabilization and functional outcomes on general population. The hypothesis is that it could do so in at-risk for dislocation athletic population for stabilization and return to sport, with results comparable to the reference techniques. METHODS: Multicenter retrospective study of Walch-Duplay type 2, 3 and 4 at risk sports patients treated by arthroscopic Trillat for chronic anterior shoulder instability between January 2012 and January 2021, at a two years follow-up. PRIMARY ENDPOINT: occurrence of dislocation recurrence. Secondary endpoints: subluxation recurrence, functional outcomes, time and level of return to sport, functional scores, bony fusion and complications. RESULTS: 74 patients were analyzed, with a mean age of 24.4 years (15-50). Sports level was, moderate risk of dislocation Walch-Duplay type 2 for n=34 (46%), medium risk Walch- Duplay type 3 for n=19 (26%) and high-risk Walch-Duplay type 4 for n=21 (28%). Recurrence of dislocation occurred in 3 patients (4.1%). 100% of patients returned to sport, with an average delay of 4.6 months, with n=56 (76%) returning to the same previous level. The mean Constant score was 94.5 (79-100), the Rowe score 94.7 (70-100), the Walch-Duplay score 90.2 (50-100) and the SSV score 90.5 (65-100). Subgroup analysis of athletes at moderate risk of dislocation recurrence (Walch-Duplay type 2) vs. medium and high risk of dislocation recurrence (Walch-Duplay type 3 and 4) revealed no statistically significant difference. One patient presented with asymptomatic pseudarthrosis. CONCLUSION: Arthroscopic Trillat offers highly satisfactory results in the treatment of chronic anterior shoulder instability for athletes regardless of the type of sport practised and type of risk according to Walch-Duplay. This simple and quick technique enables a rapid return to sport and at the previous level in the majority of cases. After showing its effectiveness in the general population at two years, arthroscopic Trillat offers a reliable alternative to the reference procedures in young athletic patients.

Approaching ramp lesions from the different world of posterior knee compartment: A review of evidence with a proposal of a new classification and treatment.

Ramp lesions (RLs) are peripheral lesions that occur in the posterior part of the medial meniscus or where it attaches to the joint capsule. The classification of the medial meniscus RLs has been the focus of numerous studies and publications. This review provides an overview of RL's current classification and treatment options in anterior cruciate ligament deficient knees. The study also aims to present a more practical classification system for RLs to assist in treatment decision-making. For the first time, we also presented a new surgical treatment for incomplete inferior and double-complete RL based on the posterior knee arthroscopy that provides direct access to the posterior meniscal borders, enabling effective treatment and stronger biomechanical repair. Level of Evidence: Level V.

A retrospective cohort study: dual cannula combined with modified shoelace continuous capsular closure technique versus nonrepair in hip arthroscopic surgery of femoroacetabular impingement.

BACKGROUND: Over the years, with the improvement of diagnostic and therapeutic capabilities for hip joint diseases and the advancements in surgical technology, hip arthroscopy has been extensively used. At present, there is ongoing controversy among scholars about whether it is necessary to close the joint capsule after hip arthroscopy. In addition, the clinical effect of repairing the hip joint capsule after hip arthroscopy remains uncertain. PURPOSE: To evaluate the effect of our modified shoelace suture technique on postoperative hip function and to investigate whether complete closure of the hip capsule is reliable and safe. STUDY DESIGN: Retrospective study; Levels of evidence: III. METHODS: A retrospective review was conducted on patients undergoing hip arthroscopy by a solitary high-volume hip arthroscopic surgeon. The patients were categorized into two groups. The first group consisted of patients who underwent the modified shoelace continuous capsular closure technique. The other group consisted of those who did not receive capsular closure after hip arthroscopy. Patient-reported outcomes including modified Harris Hip Score (mHHS), Hip Outcome Score of Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), and visual analogue scale (VAS) were obtained at a minimum of 12 months. Any complications during follow-up were identified and recorded. RESULTS: A total of 100 patients were followed up for 12-15 months, with an average of (12.3 ± 5.3) months in the study. There were 50 patients in the shoelace capsular closure group (CC group) and 50 patients in the non-capsular closure group (NC group). The surgical time in the suture group was significantly longer than that in the non-suture group. However, there was no statistically significant disparity in the length of hospital stay between the two groups. The mHHS, HOS-SSS, HOS-ADL, and VAS of the CC and NC group were significantly improved compared to preoperative scores at 6 and 12 postoperative months (P < 0.001). Compared with the NC group, the CC group showed a significant improvement in the mHHS, HOS-SSS, HOS-ADL, and VAS at 6 postoperative months (t = 4.885, P<0.001; t = 5.984, P<0.001; t = 4.279, P<0.001; t = 3.875, P<0.001). The mHHS, HOS-SSS, HOS-ADL, and VAS at 12 postoperative months were significantly better in the CC group than in the NC group (t = 5.165, P<0.001; t = 3.697, P<0.001; t = 4.840, P<0.001; t = 3.579, P = 0.001). There were no serious complications during the perioperative period. CONCLUSION: The modified shoelace continuous capsular closure technique is a reliable and secure method that can be used as an alternative to the conventional capsular closure. It is recommended to perform routine intraoperative repair of the articular capsule at the end of hip arthroscopy, as this has a positive influences on the functional results at short-term follow-up.

Analysis of risk factors and construction of nomogram model for arthroscopic single-row rivet repair.

BACKGROUND: The factors influencing the clinical outcome of arthroscopic rotator cuff repair are not fully understood. PURPOSE: To explore the factors related to the postoperative outcome of arthroscopic single-row rivet rotator cuff repair in patients with rotator cuff injury and to construct the related nomogram risk prediction model. METHODS: 207 patients with rotator cuff injury who underwent arthroscopic single-row rivet rotator cuff repair were reviewed. The differences of preoperative and postoperative Visual Analogue Score (VAS) scores and University of California, Los Angeles (UCLA) scores were analyzed and compared. The postoperative UCLA score of 29 points was taken as the critical point, and the patients were divided into good recovery group and poor recovery group, and binary logstic regression analysis was performed. According to the results of multivariate logistic regression analysis, the correlation nomogram model was constructed, and the calibration chart was used, AUC, C-index. The accuracy, discrimination and clinical value of the prediction model were evaluated by decision curve analysis. Finally, internal validation is performed using self-random sampling. RESULTS: The mean follow-up time was 29.92 ± 17.20 months. There were significant differences in VAS score and UCLA score between preoperative and final follow-up (p < 0.05); multivariate regression analysis showed: Combined frozen shoulder (OR = 3.890, 95% CI: 1.544 ∼ 9.800), massive rotator cuff tear (OR = 3.809, 95%CI: 1.218 ∼ 11.908), More rivets number (OR = 2.118, 95%CI: 1.386 ∼ 3.237), lower preoperative UCLA score (OR = 0.831, 95%CI: 0.704-0.981) were adverse factors for the postoperative effect of arthroscopic rotator cuff repair. Use these factors to build a nomogram. The nomogram showed good discriminant and predictive power, with AUC of 0.849 and C-index of 0.900 (95% CI: 0.845 ∼ 0.955), and the corrected C index was as high as 0.836 in internal validation. Decision curve analysis also showed that the nomogram could be used clinically when intervention was performed at a threshold of 2%∼91%. CONCLUSION: Combined frozen shoulders, massive rotator cuff tears, and increased number of rivets during surgery were all factors associated with poor outcome after arthroscopic rotator cuff repair, while higher preoperative UCLA scores were factors associated with good outcome after arthroscopic rotator cuff repair. This study provides clinicians with a new and relatively accurate nomogram model.

The Use of Radiosynovectomy Using Yttrium-90 as an Adjunct to Mechanical Synovectomy for Pigmented Villonodular Synovitis: How Effective Is This?

Introduction Pigmented villonodular synovitis (PVNS) or giant cell tumour of the tendon sheath (GCTT) is a rare disorder involving the proliferation of the synovium in any joint; however, the knee, hip, and ankle joints are most commonly targeted. The aim of this study is to follow the short-term outcomes of the treatment of patients with PVNS of the knee managed by intra-articular injection of yttrium-90 or radiosynovectomy (RS) alone and a combination of RS and arthroscopic/open debulking synovectomy. Methods A cohort of eight knees from six patients was included in this study, including three knees treated with combined arthroscopic synovectomy and RS, and five knees treated with RS alone. Patients were asked to complete the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire before attending their three-month follow-up appointment. Their answers were collated and scores were calculated using the designated specific equation. Results Our results demonstrate that although patients in the combined arthroscopic synovectomy and RS arm possess on average higher pain scores and symptoms than those who underwent RS alone, the combined therapy had higher scores in activities of daily living (ADLs), sports and recreation (Sport-Rec), quality of life (QoL), and overall KOOS scores. Conclusion Neoadjuvant arthroscopic mechanical debridement is a safe and quick procedure with minimal side effects, with improved overall KOOS scores.

Use of tourniquet in anterior cruciate ligament reconstruction: Is it truly necessary? A prospective randomized clinical trial.

PURPOSE: To examine the effects of tourniquet use in arthroscopic anterior cruciate ligament reconstruction in terms of (1) intraoperative visualization, (2) surgical time, (3) consumption of sterile saline, and (4) postoperative pain. METHODS: In this prospective randomized clinical trial, patients were assigned to Tourniquet Group or No Tourniquet treatment groups. The primary outcomes were intraoperative visualization, with scores ranging from 0 to 10 (0 = no visibility; 10 = clear and perfect display), surgical time, and the consumption of sterile saline. The secondary aim was to measure postoperative pain (24 h after surgery) with the visual analog scale (VAS) for pain. RESULTS: A total of 71 patients were included in the No Tourniquet group, and 75 were included in the Tourniquet group, with mean ages of 26.73 ± 8.05 years and 26.95 ± 10.11 years, respectively (p = .88). In the No Tourniquet group, 37 concomitant meniscal lesions were treated, whereas in the Tourniquet group, 38 (p = .99) were treated. The mean surgical times were 51.07 ± 6.90 and 50.03 ± 7.62 (p = .325), respectively, while the mean amount of saline consumed was 6.17 ± 1.18 L versus 5.89 ± 1.23 L (p = .217). Both groups achieved optimal visualization, with a sum of all surgical steps of 65.49 ± 1.86 for the no tourniquet group and 65.39 ± 1.88 for the Tourniquet group (p = .732). Postoperative pain was significantly lower in the No Tourniquet group (VAS score: 2.82 ± 1.33 vs 5.80 ± 1.22). CONCLUSIONS: Tourniquet use during ACL reconstruction does not improve intraoperative visualization and does not reduce surgical time but leads to greater postoperative pain with a risk of well-known tourniquet-related complications. LEVEL OF EVIDENCE: Level I - Randomized clinical trial.