The effect of virtual rainforest and a white noise mobile application on satisfaction, tolerance, comfort, and vital signs during arthroscopy.

BACKGROUND AND PURPOSE: This study was conducted to investigate the effect of Virtual Rainforest (VRF) and a White Noise (WN) mobile applications on patient satisfaction, tolerance, comfort, and vital signs during arthroscopic knee surgery. METHODS: This is a randomized, controlled, interventional study. The study was completed with a total of 93 participants, 31 in the VRF group, 31 in the WN group, and 31 in the control group. Data were collected using a Patient Information Form and a Visual Analog Scale for satisfaction, tolerance, and comfort. RESULTS: The results of study showed that there were significant increases in tolerance, satisfaction, comfort, respiratory rate, and oxygen saturation levels and significant decreases in heart rate, systolic and diastolic blood pressures in both VRF and WN groups (p < .05). In the control group, no significant difference was found between the means of the variables before and after the procedure (p > .05). CONCLUSION: According to the results of the study, VRF and WN applied during the arthroscopy procedure increased satisfaction, tolerance, and comfort in patients and had a positive effect on vital signs. TRIAL AND PROTOCOL REGISTRATION: ClinicalTrials.gov, NCT05992714.

The hue of temporomandibular joint arthroscopy under local versus general anaesthesia.

BACKGROUND: Temporomandibular joint arthroscopy (TMJA) is often performed under general anaesthesia (GA) worldwide on an inpatient basis, whereas local anaesthesia (LA) is not equally considered as the standard procedure. OBJECTIVES: To compare the efficacy between LA and GA when performing TMJA. METHODS: This study retrospectively reviewed a total of 182 patients in LA group and 91 patients in GA group who underwent TMJA for the management of disc displacement. Patients were divided into two groups based on type of anaesthesia used for surgery; LA group and GA group. Comparisons were made based on operative time, intubation and extubation time (for GA only), hospital stay duration, total cost and post-operative clinical and radiological outcomes. RESULTS: The demographics and pre-operative clinical assessments were matched in both groups. No post-operative significant difference was found in outcomes when performing TMJA under LA compared to GA in terms of pain reduction (p = .016) and improvement in mouth opening (p = .866). The median operative time and hospital stay duration for LA group were significantly less compared to GA group (p < .001). GA group required an additional intubation and extubation time, whereas LA group patients were waived from it. TMJA for LA group was performed in the minor procedure setup, which reduced the costs for surgery (p < .001). Post-operative disc position was excellent and good with an overall success rate of 95%. CONCLUSION: The use of LA performing TMJA reduces operating time, costs, hospital stay and recovery room time than GA group. Furthermore, TMJA performed under LA shared similar post-operative clinical and radiological outcomes with those performed under GA.

Diagnostic Accuracy of MRI in Knee Meniscus Tear and ACL Injury.

Objective: Knee injuries are very common and may lead to other secondary injuries if effective treatment is lacking. In addition to standardized physical examination, magnetic resonance imaging (MRI) is sometimes considered an aid in the diagnosis of knee trauma. In order to have a more accurate diagnosis of knee injuries, we compared MRI with arthroscopic findings in this study to evaluate the diagnostic accuracy of MRI for meniscal tears and anterior cruciate ligament injuries of the knee. Methods: One hundred and ten patients with suspected meniscal tears and anterior cruciate ligament injuries of the knee who were admitted to our hospital from June 2020 to June 2022 were selected as study subjects, and the clinical data of the patients were retrospectively analyzed. All patients underwent MRI for preoperative diagnosis, and the sensitivity, specificity, MRI findings, and confirmation of diagnosis were compared and analyzed, and the accuracy of MRI in diagnosing meniscal tears and ACL injuries of the knee was analyzed. Results: The mean ACL angle was (98.0 ± 5.4) in the MRI group and (118.0 ± 6.8) in the arthroscopic group, the difference between the two groups was statistically significant P < .05. The mean L/H value of the ACL was (2.12 ± 0.38) in the MRI group and (1.81 ± 0.19) in the arthroscopic group, which was statistically different between the two groups (P < .05). Among the patients, 68 meniscal injuries were found in the MRI examination, including 45 cases of knee meniscal tears and 23 cases of anterior cruciate ligament injuries. The sensitivity, specificity, positive and negative predictive values, agreement rate, kappa value, and Youden index of MRI in diagnosing meniscal tears and ACL injuries were all high. Conclusions: In terms of sensitivity and accuracy, MRI is an excellent imaging technique for the diagnosis of meniscal tears and anterior cruciate ligament injuries of the knee.

A scoping review and best evidence synthesis for treatment of partial-thickness rotator cuff tears.

BACKGROUND: Rotator cuff disorders include a broad spectrum of pathological conditions including partial-thickness and full-thickness tears. Studies have shown partial-thickness rotator cuff tear (PTRCT) prevalence to be twice that of full-thickness tears. In the working population, PTRCTs are one of the most common causes of shoulder pain and often result in occupational disability due to pain, stiffness, and loss of shoulder function. Treatment of PTRCTs remains controversial. The purpose of this study was to consolidate the existing high-quality evidence on best management approaches in treating PTRCTs using both nonoperative and operative approaches. METHODS: A scoping review with best evidence synthesis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE (OVID), EMBASE (OVID), Cochrane Library (Wiley), SCOPUS, Web of Science Core Collection, CINAHL Plus with Full Text (EBSCOhost), PubMed Central, and Science Direct were searched from 2000 to March 3, 2023. Level 1 studies, and systematic reviews and meta-analyses that included level 1 and 2 studies, were included. RESULTS: The search yielded 8276 articles. A total of 3930 articles were screened after removing 4346 duplicates. Application of inclusion criteria resulted in 662 articles that were selected for full-text review. Twenty-eight level 1 studies, 1 systematic review, 4 meta-analyses, and 1 network meta-analyses were included in the best evidence synthesis. Nonoperative strategies included injections (ie, platelet-rich plasma, corticosteroid, prolotherapy, sodium hyaluronate, anesthetic, and atelocollagen), exercise therapy, and physical agents. Operative interventions consisted of débridement, shaving of the tendon and footprint, transtendon repair, and traditional suture anchor repair techniques with and without tear completion. Both nonoperative and operative strategies demonstrated effectiveness at managing pain and functional outcome for PTRCTs. The evidence supports the effectiveness of surgical intervention in treating PTRCTs regardless of arthroscopic technique. CONCLUSION: The results of this scoping review do not support superiority of operative over nonoperative management and suggest that both strategies can be effective at managing pain and functional outcome for PTRCTs. Surgery, however, is the most invasive and costly approach, with the highest risk of complications such as infection. Other variables such as patient expectation, treating practitioner bias, or preference may change which modalities are offered and in what sequence.

Suspension fixation of iliac bone grafts under arthroscopy is an effective method for the treatment of unstable bony Bankart disease of the shoulder joint in patients with joint relaxation.

PURPOSE: To evaluate the results of arthroscopic autologous iliac bone graft suspension fixation combined with the Remplissage procedure in the treatment of recurrent shoulder dislocation with bony Bankart lesions and joint hyperlaxity. METHODS: From 2018 to 2020, 22 patients with joint laxity underwent arthroscopic autologous iliac bone graft suspension fixation and Bankart repair combined with the Remplissage procedure due to recurrent shoulder dislocation. Clinical assessment included range of motion (forward flexion, abduction, 90° external rotation, conventional external rotation, adduction, and internal rotation), visual analog scale (VAS) score, Rowe score, University of California Los Angeles (UCLA) score, and Western Ontario Shoulder Instability Index (WOSI) score. Post-operatively, the healing of the bone graft was evaluated with computed tomography (CT) scanning. RESULTS: All 22 patients were followed up for a mean of 19.3 ± 4.1 months. CT imaging showed that the healing time of the bone graft was 6-8 weeks. The patient satisfaction rate was 100%, there were no cases of redislocation, all patients returned to their preinjury training state, and the fear test was negative. At the final follow-up, the UCLA, VAS, Rowe, and WOSI scores were 29.8 ± 2.1, 2.2 ± 0.8, 89.4 ± 4.2, and 482.3 ± 46.2, respectively (p < 0.001). CONCLUSION: Arthroscopic autologous iliac bone graft suspension fixation and Bankart repair combined with the Remplissage procedure are effective in preventing recurrent instability with joint hyperlaxity. Furthermore, no patient had redislocation. LEVEL OF EVIDENCE: IV.

Effectiveness of Exercises With Electromyographic Biofeedback in Conservative Treatment of Massive Rotator Cuff Tears: A Randomized Controlled Study.

OBJECTIVE: The aim of the study is to investigate the effectiveness of a rehabilitation program with electromyographic biofeedback compared with the control group on patients with massive rotator cuff tear. DESIGN: Forty-six adults with massive rotator cuff tears, randomly assigned to 2 groups (23 electromyographic biofeedback group vs. 23 control group). The electromyographic biofeedback group (experimental group) performed the exercises under the guidance of electromyographic biofeedback, unlike the control group. All patients underwent a 45-minute training session a day, 3 times a week over a 6-wk duration, and followed up until 1-year. The outcome measures were American Shoulder and Elbow score, shoulder flexion strength, shoulder range of motion, Numeric Pain Rating Scale, and Global Rating of Change Scale. RESULTS: Compared with the control group, the electromyographic biofeedback group demonstrated a significant change in shoulder flexion strength and patient satisfaction from baseline to 6 wks (posttraining) and from baseline to 12-mo follow-up ( F = 4.671, P = 0.005). There were significant improvements in within groups statistics for American Shoulder and Elbow score, shoulder flexion strength, shoulder range of motion, and Numeric Pain Rating Scale in both groups ( P < 0.05). CONCLUSIONS: The results demonstrate that deltoid-focused structured rehabilitation program combined with electromyographic biofeedback can be used to increase shoulder flexion strength and patient satisfaction in conservative treatment of massive rotator cuff tear.

Are psychosocial variables, sleep characteristics or central pain processing prognostic factors for outcome following rotator cuff repair? A protocol for a prospective longitudinal cohort study.

INTRODUCTION: Prognosis following surgical rotator cuff repair (RCR) is often established through the assessment of non-modifiable biomedical factors such as tear size. This understates the complex nature of recovery following RCR. There is a need to identify modifiable psychosocial and sleep-related variables, and to find out whether changes in central pain processing influence prognosis after RCR. This will improve our knowledge on how to optimise recovery, using a holistic rehabilitation approach. METHODS AND ANALYSIS: This longitudinal study will analyse 141 participants undergoing usual care for first time RCR. Data will be collected 1-21 days preoperatively (T1), then 11-14 weeks (T2) and 12-14 months (T3) postoperatively. We will use mixed-effects linear regression to assess relationships between potential prognostic factors and our primary and secondary outcome measures-the Western Ontario Rotator Cuff Index; the Constant-Murley Score; the Subjective Shoulder Value; Maximal Pain (Numeric Rating Scale); and Quality of Life (European Quality of Life, 5 dimensions, 5 levels). Potential prognostic factors include: four psychosocial variables; pain catastrophising, perceived stress, injury perceptions and patients' expectations for RCR; sleep; and four factors related to central pain processing (central sensitisation inventory, temporal summation, cold hyperalgesia and pressure pain threshold). Intercorrelations will be assessed to determine the strength of relationships between all potential prognostic indicators.Our aim is to explore whether modifiable psychosocial factors, sleep-related variables and altered central pain processing are associated with outcomes pre-RCR and post-RCR and to identify them as potential prognostic factors. ETHICS AND DISSEMINATION: The results of the study will be disseminated at conferences such as the European Pain Congress. One or more manuscripts will be published in a peer-reviewed SCI-ranked journal. Findings will be reported in accordance with the STROBE statement and PROGRESS framework. Ethical approval is granted by the Ethical commission of Canton of Zurich, Switzerland, No: ID_2018-02089 TRIAL REGISTRATION NUMBER: NCT04946149.

Nursing Methods and Experience of Local Anesthesia Patients under Arthroscope.

In order to solve the nursing problems of local anesthesia patients under arthroscopy, a nursing method and experience based on local anesthesia patients under arthroscopy was proposed. From June 2019 to May 2021, 478 patients who underwent knee arthroscopy under spinal anesthesia or local anesthesia were retrospectively investigated, including 186 cases (38.9%) under local anesthesia and 292 cases (61.1%) under spinal anesthesia. 2% lidocaine plus epinephrine was injected locally and intra-articular in patients with local anesthesia, and 0.75% bupivacaine in patients with spinal anesthesia. It was found that in the local anesthesia group and spinal anesthesia group, 94.1% (175/186) and 98.3% (287/292) patients did not feel pain during operation. 93.0% (173/186 cases) and 96.2% (281/292 cases) of patients in the two groups were satisfied or very satisfied with the effect of anesthesia, respectively. The experimental results showed that local anesthesia was a simple and effective anesthesia method for knee arthroscopy, which was more reliable and safer than spinal anesthesia. Local anesthesia could be used for knee arthroscopy or cleaning and rinsing, free body removal, or even common meniscinoplasty.

Dry Arthroscopy of the Wrist With a Single-use, 1.9 mm Chip-on-tip System in Wide-awake Local Anesthesia No Tourniquet.

We retrospectively reviewed our 34 first wrist dry arthroscopy cases using a single-use, 1.9 mm chip-on-tip system in wide-awake local anesthesia no tourniquet (WALANT). Thirteen patients were acute injuries; all acute patients underwent a magnetic resonance imaging (MRI) before arthroscopy. In total, 20 of 34 patients had a preoperative MRI. We use this method as a diagnostic tool in patients with wrist pain with suspected ligament tears and for the planning of treatment. We see 2 main advantages in the use of the needle chip-on-tip system: the simplicity of the procedure, and the minimal invasive character of the procedure due to the needle size that makes it possible to perform the procedure in WALANT. We find that the needle chip-on-tip arthroscopy system is a safe and cost-efficient alternative to wrist MRI with superior diagnostic ability. The procedure is minimally invasive and well suited for WALANT.

The investigation of acute effects of fascial release technique in patients with arthroscopic rotator cuff repair: A randomized controlled trial.

BACKGROUND: Fascial release technique is used for releasing fascial tissue to decrease pain, to increase range of motion, and to improve functional level. OBJECTIVE: To investigate the acute effects of fascial release technique on pain, range of motion, upper extremity functional level, and fear of movement in individuals with arthroscopic rotator cuff repair. METHODS: Thirty volunteers with an arthroscopic rotator cuff repair were included in the study. The individuals were randomly divided into two groups. One group received only conventional physiotherapy including hot pack, interferential current, and exercise program, while the fascial release technique was applied to the other group in addition to the conventional physiotherapy program for 2 weeks with 2 sessions per week. Individuals were assessed for pain intensity, range of motion, functional level, fear of movement before and after treatment, and satisfaction level after treatment. RESULTS: Demographic and clinical characteristics of the groups were similar (p > 0.05). Both groups showed improvement in pain, range of motion, and upper extremity functions (p < 0.05). Improvements in the treatment group were better than the conventional physiotherapy group (p < 0.05). Fear of movement was significantly decreased in the treatment group (p < 0.05). Both groups were similar in terms of satisfaction level (p > 0.05). CONCLUSION: Fascial release technique is acutely effective on the pain, joint range of motion and upper extremity functions in the treatment of individuals with arthroscopic rotator cuff repair and more successful results can be obtained by including it in the early rehabilitation program after arthroscopic rotator cuff surgery.

[Open or arthroscopic arthrodesis of the ankle joint : Which is better?] / Offene oder arthroskopische Arthrodese des Sprunggelenks : Was ist besser?

Due to the change in the age structure in Germany and the steadily increasing number of fractures, arthrosis of the upper ankle joint, mainly caused by posttraumatic conditions, is becoming more and more relevant in routine trauma surgery and orthopedics. Patients suffer from reduced functionality and quality of life as well as immobilizing pain. In addition to an ankle joint prosthesis arthrodesis of the upper ankle joint offers an alternative for the treatment of advanced arthrosis. When performing an arthrodesis there is basically the option of both open and arthroscopic procedures to prepare the joint and remove the cartilage. In both procedures the upper ankle joint is usually fixed with 2-3 cannulated compression screws. Comparative studies to date have shown an advantage of the arthroscopic technique in terms of complication rate, length of hospitalization, proportion of ossification and functional outcome. The indications for arthroscopic fusion should be strictly considered, especially in the case of malalignment, as major axis corrections are difficult to perform. In such cases, open fusion of the upper ankle joint still seems superior to the arthroscopic method.

Local anesthetic volume in ultrasound-guided interscalene block and opioid consumption during shoulder arthroscopic surgery: A retrospective comparative study.

ABSTRACT: Interscalene block (ISB) is commonly performed for regional anesthesia in shoulder surgery. Ultrasound-guided ISB enables visualization of the local anesthetic spread and a reduction in local anesthetic volume. However, little is known about the appropriate local anesthetic dose for surgical anesthesia without sedation or general anesthesia. The purpose of our study was to evaluate the appropriate local anesthetic volume by comparing intraoperative analgesics and hemodynamic changes in ISB in arthroscopic shoulder surgery.Overall, 1007 patients were divided into groups 1, 2, and 3 according to the following volume of local anesthetics: 10-19, 20-29, and 30-40 mL, respectively. The use of intraoperative analgesics and sedatives, and the reduction in intraoperative maximum blood pressure and heart rate were compared through retrospective analysis.Fentanyl was used in 55.6% of patients in group 1, which was significantly higher than in those groups 2 and 3 (22.3% and 30.7%, respectively); furthermore, it was also higher than those in groups 2 and 3 in dose-specific comparisons (P < .05). The percent of the maximum reduction in intraoperative systolic blood pressure and heart rate in group 3 was significantly higher than those in groups 1 and 2. Ephedrine administration was lower in group 2 than that in other groups (P < .05). The incidence of hypotensive bradycardic events was lowest (9.1%) at the local anesthetic volume of 24 mL as revealed by the quadratic regression analysis (R2 = 0.313, P = .003).Decreasing the local anesthetic volume to less than 20 mL for ultrasound-guided ISB as the sole anesthesia increases the opioid consumption during shoulder arthroscopic surgery. Local anesthetics >30 mL or increased opioid consumption with <20 mL of local anesthetics could increase the risk of cardiovascular instability intraoperatively. Our findings indicate that 24 mL of local anesthetic could be used to lower the incidence of hypotensive bradycardic events.

Diagnostic efficacy of joint ultrasonography, dual-energy computed tomography and minimally invasive arthroscopy on knee gouty arthritis, a comparative study.

OBJECTIVE: This study aimed to investigate the diagnostic performance of minimally invasive arthroscopy for knee gout when comparing with joint ultrasonography and dual-energy computed tomography (DECT). METHODS: From January 2016 to December 2018, 121 inpatients with knee joint swelling and pain were prospectively enrolled, including 63 gout patients and 58 non-gout patients. All patients underwent pre-operative ultrasonography and DECT to evaluate knee joint monosodium urate (MSU) deposits, followed by minimally invasive arthroscopy. The gold-standard for gout diagnosis was defined as the detection of MSU crystals in the synovial fluid under polarizing microscopic or pathological analysis. RESULTS: The diagnostic results of ultrasonic double contour sign, hyperechogenic foci, MSU deposition (detected by DECT), MSU deposition (detected by arthroscopy) and MSU deposition in cartilage (detected by arthroscopy) were significantly associated with that of the gold-standard. Except for hyperechogenic foci, the other four indexes had high sensitivity and specificity (approximately or over 80%) and a large odds ratio (OR) (14.73 to 36.56), indicating good diagnostic performance. Detection of MSU deposition in cartilage by arthroscopy had a good diagnostic agreement with the ultrasonic double contour sign (κ = 0.711, p < 0.001). CONCLUSION: Joint ultrasonography, DECT, and minimally invasive arthroscopy had high sensitivity and specificity for the diagnosis of knee gouty arthritis. Minimally invasive arthroscopy was superior to joint ultrasonography and DECT, which can be a useful supplement for the diagnosis of gout. ADVANCES IN KNOWLEDGE: This is the first study comparing the diagnostic performance for knee gout among the joint ultrasonography, DECT, and minimally invasive arthroscopy.

The effectiveness of traditional Chinese medicine fumigation and washing nursing care after arthroscopic debridement of Knee Osteoarthritis: A protocol for systematic review and meta-analysis.

BACKGROUND: Knee Osteoarthritis (KOA) is a degenerative osteoarthrosis with knee joint pain as the main symptom. In recent years, arthroscopic removal of loose body and repair of meniscus have become common methods for the treatment of KOA. However, postoperative pain, swelling and limited joint movement affect the functional recovery of knee joint and the effect of surgical treatment. Early postoperative control of pain and swelling is of great significance to improve the curative effect of arthroscopic debridement and promote the recovery of knee joint function. In recent years, many clinical studies have reported that the nursing method of fumigation and washing with Chinese medicine after arthroscopic debridement of KOA can relieve pain, promote the recovery of joint function and improve the clinical curative effect, but there is a lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of fumigation and washing with traditional Chinese medicine after KOA arthroscopy. METHODS: Computer retrieval English database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese database (China National Knowledge Infrastructure, Wanfang, VIP Database for Chinese Technical Periodicals, China Biology Medicine disc), moreover manual retrieval academic, Google and baidu from building to since December 2020, traditional Chinese medicine fumigation applied to KOA arthroscopy postoperative nursing of randomized controlled clinical research, by two researchers independently evaluated the quality of the included study and extracted the data. Meta-analysis of the included literatures was performed using RevMan5.3 software. RESULTS: The main observation index of this study was the effective rate, and the secondary indexes included Visual Analogue Scale Score, the Western Ontario and McMaster university orthopedic index, Lysholms score and adverse reactions, so as to evaluate the efficacy and safety of traditional Chinese medicine fumigation nursing after KOA arthroscopy. CONCLUSION: This study will provide reliable evidence for the clinical application of Fumigation and washing nursing of traditional Chinese medicine after KOA arthroscopy. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/THZP4.

Short-term effect of electroacupuncture on rehabilitation after arthroscopic triangular fibrocartilage complex repair: a randomised study.

BACKGROUND: Electroacupuncture (EA) alleviates chronic pain and acute postoperative pain after several surgical procedures. However, whether EA facilitates postoperative functional recovery after arthroscopic surgery has yet to be determined. This study investigated the short-term effect of EA on a rehabilitation course after arthroscopic triangular fibrocartilage complex (TFCC) repair. METHODS: Forty-two patients undergoing arthroscopic TFCC repair were randomised to an EA group (n = 19) or control group (n = 23). In the EA group, patients received EA treatment and standard active rehabilitation for 4 weeks. In the control group, patients received standard active rehabilitation for 4 weeks. At the end of the treatment and at the follow-up visit 4 weeks after the treatment, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, wrist range of motion (ROM), handgrip strength, and key pinch strength were collected and analysed. RESULTS: The EA group improved significantly than the control group in terms of DASH scores, all wrist motion arcs, and key pinch strength (P < 0.05) at the end of the 4-week treatment and the follow-up visit another 4 weeks later. CONCLUSION: Patients treated with 4 weeks of EA after the arthroscopic TFCC repair had better wrist ROM and DASH scores than patients of control group.

A predictive model with radiographic signs can be a useful supplementary diagnostic tool for complete discoid lateral meniscus in adults.

PURPOSE: To investigate the diagnostic accuracy of radiographic signs for complete discoid lateral meniscus and whether a predictive model combining the radiographic signs can improve its diagnostic accuracy in adults. METHODS: A total of adult 119 knees with complete discoid lateral meniscus confirmed by arthroscopy and 119 age- and sex-matched knees with normal meniscus were included. The radiographic signs of lateral joint space, fibular head height, lateral tibial spine height, lateral tibial plateau obliquity, lateral femoral condyle squaring, lateral tibial plateau cupping, lateral femoral condyle notching, and the condylar cut-off sign were evaluated. The receiver-operating characteristic (ROC) curves and area under the curve (AUC) were evaluated for best accuracy. A prediction model was developed by multivariable regression with generalized estimating models, and was validated using data from 111 knees of children with complete discoid lateral meniscus and 111 normal controls. RESULTS: The fibular head height, lateral joint space, lateral tibial plateau obliquity, and the condylar cut-off sign were significantly different between the complete discoid lateral meniscus and the normal groups (p < 0.05). Among the four radiographic signs, the fibular head height showed the highest accuracy with 78.9% sensitivity and 57.3% specificity. The prediction models developed by logistic regression showed significantly improved accuracy for complete discoid lateral meniscus compared to the fibular head height (sensitivity: 69.8%, specificity: 82.9%, p = 0.001). For validation, the AUC of children seemed to be larger than that of adults, which indicated that the prediction models could be applied for children to detect complete discoid lateral meniscus. CONCLUSION: Among several radiographic signs, the fibular head height can be used as a screening tool for complete discoid lateral meniscus. The prediction models combined with lateral joint space, fibular head height, lateral tibial plateau obliquity, and/or the condylar cut-off sign yielded a much higher diagnostic value than each radiographic sign. Therefore, fibular head height and prediction models combined with radiographic signs can provide improved diagnostic value for complete discoid lateral meniscus. LEVEL OF EVIDENCE: III.

Local anesthesia combined with intra-articular ropivacaine can provide satisfactory pain control in ankle arthroscopic surgery: A retrospective cohort study.

BACKGROUND: Local anesthesia (LA) is widely used in knee arthroscopic surgery but not in ankle arthroscopy. OBJECTIVE: To understand the effectiveness and safety of LA combined with ropivacaine in pain control for ankle arthroscopy. STUDY DESIGN: Retrospective cohort. METHODS: We retrospectively collected data for patients who underwent ankle arthroscopy from April 2012 to April 2017. Patients were grouped by anesthesia method: LA, LA with ropivacaine (LA+R), spinal anesthesia (SA), and SA with ropivacaine (SA+R). Intra- and postoperative visual analog scale (VAS) scores, complications, doses of supplemental pain medication, hospitalization cost and duration, and satisfaction with pain control during hospitalization were analyzed. RESULTS: The study included 276 patients (LA: 93; LA+R: 124; SA: 31; SA+R: 28). The LA and LA+R groups had significantly higher intraoperative VAS scores (LA vs. SA, p = 0.001; LA vs. SA+R, p = 0.002; LA+R vs. SA, p = 0.00; LA+R vs. SA+R, p = 0.00), but fewer complications, than the SA and SA+R groups. The LA+R and SA+R groups had significantly better outcomes for postoperative pain control (LA vs. LA+R, p = 0.01; LA vs. SA+R, p = 0.01; SA vs. SA+R, p = 0.01; SA vs. LA+R, p = 0.03) and required less supplemental pain medication. Hospitalization cost was lower and duration shorter in the LA and LA+R groups than in the SA and SA+R groups. There was no significant difference in satisfaction among the four groups. LIMITATIONS: This was a single-center retrospective and relatively short-term study. CONCLUSIONS: LA+R which could be safely applied in ankle arthroscopy provided satisfactory pain control, reduced postoperative pain intensity, fewer complications, shorter hospital stay, and good cost-effectiveness. It can be safely applied in ankle arthroscopy for the specific patients with ankle osteoarthritis.

Preoperative hypnosis for pain management after arthroscopic repair of anterior cruciate ligament.

BACKGROUND: The practice of hypnoanalgesia in orthopedics is rare and the literature is poor. AIM: The purpose of this pilot study was to verify the efficacy of hypnosis for the management of postoperative analgesia after arthroscopic repair of anterior cruciate ligament. METHODS: This was a prospective clinical trial over a period of 6 months (March - August 2015) including 25 patients scheduled for arthroscopic repair of anterior cruciate ligament under spinal anesthesia. All these patients had preoperative hypnosis in addition to the standard multimodal analgesia protocol (group H) and were compared to historical group (group S) who received only a standard multimodal analgesia protocol. RESULTS: Pain scores were significantly lower for the hypnosis group during the first 48 hours postoperatively (p = 0,006). The total dose of morphine at 48 hours was: 13,6 mg (95% CI [4,58; 22,62]) in the group H and 10,2 mg (95% CI [1,64 ; 18,76]) in group S with no statistically significant difference (p = 0,178) Conclusion: Results of this pilot study in orthopedic surgery suggested that hypnosis reduced postoperative pain scores as demonstrated in other surgeries.

Comparison of Platelet Rich Plasma and Prolotherapy in the Management of Osteochondral Lesions of the Talus: A Retrospective Cohort Study.

BACKGROUND Osteochondral lesions of talus (OLT) are among the most common ankle problems. Platelet-rich plasma (PRP) and prolotherapy (PrT) are 2 successful injection-based techniques for treatment of chronic musculoskeletal problems. The aim of the present study was to compare PRP and PrT injections for the management of OLT. MATERIAL AND METHODS This was a retrospective cohort study of 49 patients with OLT symptoms of more than 6 months who had been refractory to 3 months of treatment using conservative methods. The patients were divided into 2 groups: PrT injections (PrT group, n=27) or PRP injections (PRP group, n=22). The patients were given 3 injections of 4 mL solution into periarticular and intra-articular ankle joint spaces. After treatment, patients were evaluated via Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Society Score (AOFAS), and Ankle Osteoarthritis Scale (AOS) at baseline and 21-, 90-, 180-, and 360-day follow-up periods. RESULTS Both PRP and PrT treatments resulted in greater improvement in pain and ankle functions at follow-up periods extending to 1 year (P<0.001) and there was no difference between the groups for the outcomes at follow-up periods (P>0.05). Excellent or good outcomes were reported by 88.8% of the patients in PrT group and 90.9% of the patients in PRP group. CONCLUSIONS Both PRP and PrT are efficient and safe methods in treatment of OLT. PrT offers advantages of less cost and minimal invasiveness.

Ultrasound-guided percutaneous irrigation of calcific tendinopathy: technical developments.

Rotator cuff calcific tendinopathy (RCCT) is a common and painful shoulder disease characterised  by deposition of calcium into the rotator cuff's tendond. Different therapeutic options have been proposed, but the ultrasound-guided percutaneous irrigation (US-PICT) is been proved as an effective and safe first-line treatment. It can be performed with a single- of a double-needle tecnique, using warm saline solution to improve the dissolution of the calcific deposit. The procedure is ended with an intrabursal injection of local anaesthetics and slow-release steroids to improve the pain relief and to prevent complications. US-PICT leads to significative improvement in the shoulder funtion and pain relief in the short and long term, with a low complications rate.