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).

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.

Comparative clinical efficacy of "Figure-8" Banding and double-row anchor suture-bridge fixation in arthroscopic management of tibial intercondylar eminence avulsion fractures.

OBJECTIVE: The objective of this study is to assess and compare the clinical efficacy of "Figure-8" banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures. METHOD: A retrospective analysis was conducted on the medical records of 42 patients who underwent arthroscopic surgery for tibial intercondylar eminence fractures at our institution from June 2017 to June 2022. This cohort included 20 cases treated with "Figure-8" banding and 22 cases managed using double-row anchor suture-bridge fixation. Comparative assessments were made regarding operative duration, duration of fracture consolidation, postoperative knee joint range of motion, joint stability as assessed by the Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) functional score for both treatment groups. RESULTS: The mean follow-up duration was 13.8 months. The analysis indicated that the double-row anchor suture-bridge group had a significantly longer operative duration compared to the "Figure-8" banding group (p < 0.05). Postoperative computed tomography (CT) scans confirmed successful reduction in both groups, with fracture consolidation achieved within an average of three months. Both groups showed significant improvements in postoperative knee range of motion, joint stability, and functional scores compared to preoperative measurements (p < 0.05). During the initial two-month post-surgery, the double-row anchor suture-bridge group demonstrated superior knee joint range of motion and functional scores compared to the "Figure-8" banding group (p < 0.05); however, these differences were not statistically significant beyond three months post-surgery (p > 0.05). By the one-year postoperative mark, joint stability outcomes were comparable between the two treatment groups (p > 0.05). CONCLUSION: Both "Figure-8" banding and double-row anchor suture-bridge fixation techniques in the arthroscopic management of tibial intercondylar eminence avulsion fractures can achieve precise reduction and stable fixation. In addition, the figure-8 suture group has the characteristics of shorter surgery time and less cost. Notably, early postoperative knee function appears to be superior with double-row anchor suture-bridge fixation compared to "Figure-8" banding.

Synovial Chondromatosis of the Knee Joint: Management With Arthroscopy-Assisted "Sac of Pebbles" Extraction and Synovectomy.

Synovial chondromatosis is a rare, benign condition characterized by the formation of intra-articular cartilaginous loose bodies, which arise as a result of synovial membrane metaplasia. Due to pain, edema, and joint dysfunction, synovial chondromatosis can result in severe morbidity even though it is a self-limiting condition. In order to avoid problems, such as joint degeneration, early diagnosis and treatment is essential. This case study presents a female patient, age 24, who has experienced increasing pain, swelling, and occasional locking in her left knee for the past two years. Clinical examination of the suprapatellar pouch revealed several palpable loose bodies and effusion. Several intra-articular loose bodies were confirmed by imaging techniques. The patient underwent arthroscopic removal of multiple loose bodies and synovectomy. Histopathological examination confirmed the diagnosis as primary synovial chondromatosis. Postoperatively, the patient achieved a full range of movement without pain, and recurrence was not observed after three months of follow-up. For the treatment of knee synovial chondromatosis, an efficient and less invasive method is the arthroscopy-assisted removal of loose bodies and synovectomy. The value of this method in treating this uncommon condition is emphasized by the significant functional recovery and the lowered risk of recurrence.

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.

Arthroscopic Chondral Nail Fixation for Treating Acetabular Cartilage Delamination Results in Improved Pain Relief at Minimum 2-year Follow-up in Patients with Femoroacetabular Impingement Syndrome: A Propensity-Matched Study.

PURPOSE: To investigate the clinical outcomes following arthroscopic chondral nail fixation for acetabular cartilage delamination (ACD) in patients with femoroacetabular impingement syndrome (FAIS), and the presentation of ACD on MRI at follow-up. METHODS: A retrospective review was performed between March 2021 and March 2022 at our institute. Patients undergoing primary hip arthroscopy for FAIS and diagnosed with ACD intraoperatively were included. Exclusion criteria were incomplete data or loss of minimum 2-year follow-up, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). Patients who underwent chondral nail fixation were matched 1:1 with a control cohort of patients who only underwent simple debridement. Preoperative and minimum 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were collected and compared. MRI was performed preoperatively and at final follow-up to assess ACD. RESULTS: Fifty-eight patients were included in the study (29 patients in each group). Both groups demonstrated improved VAS and mHHS following surgery (all with P < .05). The chondral nail group demonstrated better postoperative VAS (P = .022) compared to the control group, while the postoperative mHHS was comparable between the two groups (P = .852). No significant difference was found in the achievement of MCID between the two groups (all with P > .05). More patients in the chondral nail group achieved PASS of VAS compared to the control group (75.9% vs 48.3%, P = .030). No patient underwent revision surgery or conversion to total hip arthroplasty (THA). The chondral nail group demonstrated significantly higher rate of ACD healing on MRI compared to the control group (P < .001). CONCLUSION: Patients undergoing arthroscopic chondral nail fixation for treating ACD demonstrated significant pain relief, more achievement of PASS of VAS, and higher rate of ACD healing on MRI compared to those undergoing simple debridement. LEVEL OF EVIDENCE: Level III; retrospective cohort study.

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.

Arthroscopy has a higher discriminative capacity than MRI in detecting mild cartilage lesions.

OBJECTIVES: To determine whether current magnetic resonance imaging (MRI) could detect superficial cartilage lesions that are observed during diagnostic arthroscopy in patients with knee pain who have not been diagnosed with joint disease. METHODS: Adult patients with knee pain of unclear origin lasting more than three months, scheduled for a therapeutic/diagnostic arthroscopy were recruited. Demographic and clinical data, pain assessment, MRI imaging, and observations of cartilage damage in the medial femoral condyle during arthroscopic procedure were documented. Patients were categorized based on the presence of cartilage damage assessed via MRI and/or direct visualization. Concordance between these assessments and its variation with age and patient-reported pain were examined. RESULTS: Out of the 95 patients recruited, 48 exhibited lesions in the medial femoral condyle (MFC) during arthroscopic examination, while only 24 of them showed lesions on the MRI scans. The thickness of the cartilage in the MFC was significantly lower in patients with cartilage damage detected by MRI compared with those without. Among patients with cartilage lesions identified during arthroscopy, those also showing lesions on the MRI had lower cartilage thickness and higher Outerbridge score than those without lesions on the MRI. Patients with detectable cartilage damage on the MRI were significantly older and reported higher levels of pain than those with damage detected only by arthroscopic examination. CONCLUSION: Despite significant technological advancements in MRI, arthroscopy still proves superior in identifying mild structural cartilage lesions that are not identifiable by this technique.

Hip shelf acetabuloplasty in borderline dysplasia, an alternative between Periacetabular Osteotomy and arthroscopic procedures.

PURPOSE: Surgical treatments for symptomatic borderline dysplastic hips (Lateral Center-Edge Angle: LCEA 18-25°) remain challenging, instability being the primary issue. Currently, treatment options include arthroscopic procedures or peri-acetabular osteotomy (PAO). Although the popularity of the acetabular shelf bone block has declined in favor of PAO, it may still be relevant as a hip joint stabilizer and coverage area, rather than for increasing coverage area by cartilage. We analyzed clinical and radiographic outcomes of 23 borderline hips after undergoing shelf procedure with a minimum follow-up of two years. METHODS: This is a retrospective descriptive study. Clinical evaluations (modified Harris Hip Score: mHHS, Non-Arthritic Hip Score: NAHS, International Hip Outcome Tool: iHOT12) and radiographic assessments were performed before and after surgery. We collected data on revision surgery rates, associated surgical procedures (labrum, impingement), complications, arthrosis progression, and conversion to total hip replacement (THR). RESULTS: The mean LCEA was 21°, and the mean follow-up period was five years (2 to 14 years). Clinical scores showed significant improvement at the last follow-up, mHHS increasing from 47 to 72 (p < 0.001), NAHS from 42 to 68 (p < 0.001), iHOT12 from 28 to 52 (p < 0.001), and pain levels decreasing from 7 to 3. Revision surgery rate was 13%, and complication rate was 8%. No osteoarthritis beyond Tönnis grade 2, and no cases required conversion to THR. CONCLUSION: Arthroscopic procedures and PAO have shown promising results in the treatment of borderline hips. The hip shelf procedure appears to be a simple and effective treatment for stabilizing borderline hips, with favorable outcomes for 80% of patients and a low rate of arthritic progression. Shelf procedure could be a valuable addition to the therapeutic options for painful borderline dysplasia of the hip.

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 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.

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.

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.

Retrospective Comparison of Quadratus Lumborum and Pericapsular Nerve Group Blocks for Postoperative Pain Management of Patients Undergoing Outpatient Hip Arthroscopy.

Introduction: Hip arthroscopy is commonly performed as an outpatient procedure and effective postoperative pain management is important to provide quality patient care and enable timely discharge. Multiple regional nerve blocks have been described for pain relief after hip arthroscopy, but there is no consensus on the optimal technique. This retrospective investigation aimed to compare quadratus lumborum (QL) and pericapsular nerve group (PENG) blocks to determine if there are differences in analgesic outcomes after outpatient hip arthroscopy. Methods: A total of 50 consecutive patients that received QL block and 50 that received PENG block for outpatient hip arthroscopy were identified and compared to determine if there were any differences in the primary outcome of total perioperative opioid consumption prior to discharge from the surgery center. Important secondary analgesic outcomes include postoperative opioid consumption, verbal rating scale (VRS) pain scores or total time in the recovery area. Summary statistics of relevant variables are compared and reported between study groups (QL versus PENG). Results: For QL and PENG groups, no significant differences were observed in total perioperative oral morphine equivalents (OME) (69.5 vs 60mg; p=0.40), postoperative OME (15 vs 15.3mg; p=0.96) or maximum pain scores in the recovery area (7.0 vs 6.0; p=0.41). Postoperatively, QL block patients were in PACU for a greater length of time after surgery than PENG block patients (89.5 vs 72 minutes; p<0.001). No patients had uncontrolled pain requiring emergency room visits or hospital admission within 24 hours. No neurologic complications or instances of motor weakness were reported after QL or PENG blocks. Conclusion: This retrospective study observed similar opioid requirements and pain scores for patients receiving QL versus PENG block for hip arthroscopy, though PENG block patients had shorter times in the recovery area. Prospective, controlled trials are required to further explore and confirm these findings.

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.