Arthroscopic surgical treatment for neglected congenital muscular torticollis in adults.

BACKGROUND: Congenital muscular torticollis (CMT) is the third most common congenital musculoskeletal anomaly. The efficacy of surgical treatment of neglected CMT after skeletal maturity in adults remains controversial. The aim of this retrospective study was to determine the efficacy of arthroscopic release of the sternocleidomastoid (SCM) muscle for the treatment of neglected CMT in adult cases. METHODS: From April 2008 to July 2013, a total of 20 adult patients (9 men and 11 women) with a mean age of 23.0 years were surgically treated for neglected CMT with local anesthesia. The SCM muscle and clavicle were preoperatively marked. Through an artificial lacuna, an arthroscope and a radiofrequency probe were inserted. The sternal and clavicular attachments were dissected and divided via radiofrequency. Clinical evaluation was assessed using a modified Cheng and Tang score. RESULTS: The operation was successfully completed in all the patients. Follow-up examinations from 12 to 40 months in the 20 patients showed complete muscular release and satisfactory cosmetic appearance with no recurrence. There was no evidence of serious complications. The neck scars were no longer visible after several weeks. According to the modified Cheng and Tang scale, 11 patients displayed an excellent result and 9 patients had a good result. CONCLUSIONS: Arthroscopic release of the SCM muscle with local anesthesia is a simple and effective way to surgically manage neglected CMT without any risk for either damage to the neurovascular structures or leaving visible scars.

[Arthroscopic repair of meniscus injury with Fast-fix under local anesthesia].

OBJECTIVE: To evaluate the clinical outcome of arthroscopic repair method of meniscus injury with Fast-fix under local anesthesia. METHODS: From October 2005 to September 2012,106 patients with meniscus injuries admitted into our - hospital were studied, including 74 males and 32 females, ranging in age from 13 to 71 years old, averaged 27.6 years old. The duration of the disease ranged from 15 days to 5 years. The main clinical manifestations included knee joint pain after exercise, joint locking, pressing pain of knee joint and positive McMurray signs. The MRI showed meniscus tear or degeneration. Arthroscopic repairing surgeries were performed with Fast-fix under local anesthesia. Each patient was assessed with VAS pain evaluation and Lysholm knee-joint score system before and after operation. All the patients were followed up more than 1 year. RESULTS: One hundred and 2 patients were followed up by recording subjective symptoms, clinical examinations and questions naires for an average of 2.6 years (ranged, 1.1 to 8 years), and 4 patients lost follow-up. All the 102 patients had no anesthetic complications. Ninety-six patients had normal subjective symptom and clinical examinations. Four patients had a mild ache with activities,2 patients had moderate pain after activities with joint space pressing pain. VAS pain evaluation and Lysholm knee-joint score after operation both were much better than that before operation. CONCLUSION: onclusion: Local anesthesia can provide nice circumstances for surgeries. Arthroscopic repair using Fast-fix is an idea method for meniscus injury, especially for the posterior horn tear of medial meniscus, which is simple and convenient with less complications, and satisfactory results.

[Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee under local anesthesia].

OBJECTIVE: To evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. METHODS: Between June 2002 and January 2013, 145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia (local anesthesia group). In addition, 51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group. No significant difference was found in gender, age, side, disease duration, or cyst size between 2 groups (P > 0.05). Then, anesthesia time, analgesia effect, anesthesia satisfaction, operation time, bleeding volume, and anesthesia complication were compared between 2 groups. The guidelines of Rauschning and Lindgren were used to assess the effectiveness, and recurrence rate was recorded. Results All incisions healed primarily, no neurological or vascular injury was found. The patients were followed up 1 year and 1 month to 8 years (mean, 3.7 years) in local anesthesia group, and 8 years to 13 years and 7 months (mean, 10.8 years) in control group. Local anesthesia group had shorter anesthesia time, higher visual analogue scale (VAS) score, shorter operation time, and lower bleeding volume (P < 0.05) than control group. Anesthesia satisfaction was reduced in local anesthesia group, but there was no significant difference (χ2 = 0.071, P = 1.000). The anesthesia complication incidence of control group (15.7%, 8/51) was significantly higher than that of local anesthesia group (0) (P = 0.000). Recurrence was found in 12 patients of local anesthesia group (curative ratio 9.7%) and in 5 patients of control group (curative ratio 90.2%), showing no significant difference (χ2 = 0.111, P = 0.774). According to the guidelines of Rauschning and Lindgren, there were 131 cases of grade 0, 13 cases of grade I, and 1 case of grade II in local anesthesia group, and 37 cases of grade 0, 12 cases of grade I, and 2 cases of grade II in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups (Z = -10.683, P = 0.000; Z = -6.385, P = 0.000), and between 2 groups at post-operation (Z = -3.145, P = 0.002). CONCLUSION: Compared with under continuous epidural anesthesia, arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results. Under local anesthesia, the condition of nerve and vessel can be timely and dynamically observed. Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma, lower recurrence rate, and satisfactory results.