Predictors of Postoperative Outcomes after Arthroscopic Partial Meniscectomy: A Retrospective Analysis.

OBJECTIVE: Arthroscopic partial meniscectomy is a widely used surgical technique for treating meniscus injuries, while individual differences in postoperative outcomes remain a significant concern. This retrospective study aimed to identify the factors influencing clinical outcomes following arthroscopic partial meniscectomy. METHODS: We retrospectively examined the clinical data of 52 patients who underwent arthroscopic partial meniscectomy at our institution from January to May 2022. Observation indicators, including gender, age, type of medical insurance, various surgeons, the self-pay portion of hospital costs, and total hospital costs, were systematically recorded. Subjective symptoms were evaluated with ΔTenger, ΔLysholm, and International Knee Documentation Committee (IKDC) scores during follow-up. The trends of the above questionnaires and potential predictors were statistically evaluated through regression analysis. RESULTS: Binary logistic analysis revealed that female patients (OR: 32.42; 95% confidence interval [CI]: 2.22, 473.86) and higher preoperative visual analog scale (VAS) (odds ratio [OR]: 3.58; 95% CI: 1.55, 8.28) were significantly associated with FP Lysholm score. Similarly, patients with elevated preoperative VAS (OR: 1.47; 95% CI: 1.01, 2.15) were significantly more likely to have FP IKDC scores. Multiple linear regression analysis revealed that traumatic meniscus tear (ß = -0.324; 95% CI: -0.948, -0.036; p = 0.035) emerged as a negative independent predictor of ΔTegner, while higher preoperative VAS scores (ß = 0.330; 95% CI: 0.013, 0.217; p = 0.028) were identified as positive independent predictors of ΔTegner. The duration of symptoms (ß = -0.327; 95% CI: -0.010, -0.001; p = 0.023) had a negative impact on the ΔLysholm scores. Factors such as body mass index (BMI) (ß = -0.250; 95% CI: -1.000, -0.020; p = 0.042), duration of symptoms (ß = -0.302; 95% CI: -0.009, -0.001; p = 0.014), and preoperative VAS (ß = -0.332; 95% CI: -1.813, -0.250; p = 0.011) were negatively associated with ΔIKDC scores. CONCLUSION: The study offers insights into multiple factors for patient outcomes after arthroscopic partial meniscectomy. Orthopedic surgeons need to consider variables such as gender, BMI, duration of symptoms, preoperative VAS, and the traumatic/degenerative types of meniscal tears to optimize postoperative outcomes.

Arthroscopic Excision of a Solitary Intra-articular Osteochondroma Manifesting as a Loose Body: A Presentation of an Extremely Rare Medical Condition.

Osteochondroma typically has extra-articular growths at the metaphysis. Intra-articular osteochondroma is extremely uncommon. We report a case of a 55-year-old woman who had been experiencing right knee pain for the past 12 months. An arthroscopy revealed a medial meniscus tear with a loose body in the right knee. It was removed arthroscopically. Histopathology identified it as an osteochondroma. Therefore, intra-articular osteochondroma can be regarded as an uncommon cause of loose bodies in adult patients.

Clinical study on improving the diagnostic accuracy of adult elbow joint cartilage injury by multisequence magnetic resonance imaging.

BACKGROUND: Due to frequent and high-risk sports activities, the elbow joint is susceptible to injury, especially to cartilage tissue, which can cause pain, limited movement and even loss of joint function. AIM: To evaluate magnetic resonance imaging (MRI) multisequence imaging for improving the diagnostic accuracy of adult elbow cartilage injury. METHODS: A total of 60 patients diagnosed with elbow cartilage injury in our hospital from January 2020 to December 2021 were enrolled in this retrospective study. We analyzed the accuracy of conventional MRI sequences (T1-weighted imaging, T2-weighted imaging, proton density weighted imaging, and T2 star weighted image) and Three-Dimensional Coronary Imaging by Spiral Scanning (3D-CISS) in the diagnosis of elbow cartilage injury. Arthroscopy was used as the gold standard to evaluate the diagnostic effect of single and combination sequences in different injury degrees and the consistency with arthroscopy. RESULTS: The diagnostic accuracy of 3D-CISS sequence was 89.34% ± 4.98%, the sensitivity was 90%, and the specificity was 88.33%, which showed the best performance among all sequences (P < 0.05). The combined application of the whole sequence had the highest accuracy in all sequence combinations, the accuracy of mild injury was 91.30%, the accuracy of moderate injury was 96.15%, and the accuracy of severe injury was 93.33% (P < 0.05). Compared with arthroscopy, the combination of all MRI sequences had the highest consistency of 91.67%, and the kappa value reached 0.890 (P < 0.001). CONCLUSION: Combination of 3D-CISS and each sequence had significant advantages in improving MRI diagnostic accuracy of elbow cartilage injuries in adults. Multisequence MRI is recommended to ensure the best diagnosis and treatment.

Computer assisted surgical anatomy mapping (CASAM) of the distal Posterior Interosseous Nerve (PIN) and its relation to the wrist arthroscopy portals: A cadaver study.

Introduction: The distal Posterior Interosseous Nerve (PIN) plays an important part in the sensory innervation of the wrist joint. Introduction of the arthroscopy portals during wrist arthroscopy might injure the PIN. The anatomic variation in the trajectory of the PIN and the proximity to the dorsal arthroscopy portals have not yet been fully explored. Materials and methods: Computer assisted surgical anatomy mapping (CASAM) is a technique to digitally compute and merge photographic images using anatomic landmarks and visualize variation in anatomy. A standard wrist arthroscopy procedure was carried out on eight cadaver forearms. CASAM was used to map the trajectory of the distal PIN and measure the distance to bony landmarks and the nearest wrist arthroscopy portals. Descriptive statistics were provided for anatomical measurements. Results: CASAM illustrated great variation in the PIN trajectories between the specimens. The mean distance from the PIN to Lister's tubercle was 9 â€‹mm (range 3-14, SD 3.9), the distance to the ulnar styloid was 27 â€‹mm (range 23-32, SD 3.3). None of the nerves showed signs of iatrogenic injury from placement of the arthroscopy portals. The 3-4 portal and the 6R portal were closest to the PIN with a respective mean distance of 9 â€‹mm (range 4-15, SD 3.8) and 19 â€‹mm (range 13-22, SD 3.2). Conclusion: CASAM demonstrated the importance of understanding nerve anatomy variations and offered insight into which arthroscopy portals are most likely to damage the distal PIN. However, we conclude that the overall risk of PIN injury from wrist arthroscopy is low due to the proximity to the portals.

NanoScope wrist arthroscopy under wide-awake local anesthesia with no tourniquet: A prospective series of 30 consecutive patients.

Introduction: Wrist arthroscopy is an evolving procedure. The purpose of this study was to report the outcome of diagnostic arthroscopy of the wrist using a new tool, the NanoScope, under wide-awake local anesthesia with no tourniquet (WALANT). Patients and methods: This was a prospective study of 30 consecutive patients with suspected ligament tear after wrist trauma and remaining symptoms after initial conservative management. All patients had an MRI prior to the NanoScope procedure. Results: The patients comprised 17 men and 13 women, with a mean age of 31 years. One patient declined the NanoScope procedure following their MRI. In the remaining 29 patients, NanoScope wrist arthroscopy revealed 19 cases of triangular fibrocartilaginous complex (TFCC) tears and 11 tears of the scapholunate (SL) or lunotriquetral (LT) ligaments. The correlation between preoperative MRI and the findings from NanoScope arthroscopy was poor. Six patients had additional surgery after the NanoScope arthroscopy, comprising three TFCC sutures, one SL and one LT ligament reconstruction respectively, and one wrist arthrodesis. No complications related to the NanoScope arthroscopies were noted. Conclusion: NanoScope arthroscopy of the wrist is safe, is well-suited for surgery in WALANT, and has superior diagnostic capacity compared to MRI. Further studies are warranted to determine the role of the NanoScope in the management of wrist ligament pathologies. Level of evidence: This is a level 4 study.

Arthroscopic Assessment of the Incidence of Biceps Pulley Lesions Associated With Rotator Cuff Tears: An Observational Study.

The shoulder joint houses a stabilizing structure called the biceps pulley. Biceps pulley lesions can trigger anterior shoulder pain and frequently coincide with rotator cuff tears, whose prevalence rises with age. In our study, we aim to assess the incidence of biceps pulley lesions associated with rotator cuff tears in patients undergoing arthroscopic repair, the possible associated factors, and whether MRI findings were correlated with them. This study was a prospective observational one conducted at Al-Hadra University Hospital. The patients aged 40 to 65 years were indicated for arthroscopic repair of a rotator cuff tear. We used IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. to conduct the analysis. A total of 60 patients were enrolled in the study. The mean age was 50.97 ± 6.90. The overall incidence of biceps pulley lesions was 85%. Older age was found to be significantly associated with increased incidence. On the other hand, gender, and the mode of injury (cuff tear) had no significant associations with the incidence. Also, formal MR had no significance in diagnosing biceps pulley lesions. The overall incidence of biceps pulley lesions in the current study was 85%. The older the patient with a cuff tear, the greater the incidence of finding a pulley lesion arthroscopically. Moreover, MRI did not have a significant role in diagnosing the biceps pulley lesions.

Giant Cell Tumor as a Rare Cause of Loose Bodies in the Knee Joint - A Case Report.

Introduction: Loose bodies in the knee joint are relatively common and the common causes are transchondral fractures, synovial chondromatosis, osteochondritis dissecans, meniscal injury, and osteoarthritis. Neoplastic growths from synovium have been reported to have presentations mimicking loose bodies or meniscus tears. Case Report: We report the case of an unusual cause of loose body in the knee joint of a 35-year-old male who reported for follow-up 3 years after the surgical management of giant cell tumor (GCT) of the distal femur. He had symptoms of loose bodies in the joint without any complaint specific to the operative site. Imaging revealed loose bodies within the joint which were removed arthroscopically. Histopathology showed the loose bodies as GCT. The patient had relief of symptoms after removal and the patient has no evidence of recurrence at the primary site or in the knee joint. Conclusion: GCTs should be considered a cause of loose bodies in the joint when there is a neighboring bone affected by GCT and all such loose bodies removed should undergo histopathological examination.

Patients Undergoing Revision Hip Arthroscopy With Labral Reconstruction or Labral Repair and Patient-Reported Outcomes: A Systematic Review.

Background: Compromise of the acetabular labrum can lead to pain and loss of critical intra-articular fluid pressure. Revision labral preservation poses unique challenges due to adhesions and compromised tissue quality. Purpose/Hypothesis: The purpose of the study was to evaluate patient-reported outcome (PRO) measures (PROMs) in patients undergoing revision hip arthroscopy with either labral reconstruction or labral repair after primary hip arthroscopy for labral tear. It was hypothesized that both procedures would lead to improved PROs. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was conducted with the following keywords: (revision) AND (hip OR femoroacetabular impingement) AND (arthroscop*) AND (reconstruction OR repair) in PubMed, Cochrane, and Scopus in August 2023 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, yielding 2002 initial records. Only studies comparing PROMs between revision labral reconstruction or revision labral repair after primary hip arthroscopy for labral tear were included. Background article information was recorded, including article title, author, study design, level of evidence, patient demographics, radiographic information, intraoperative data, PROMs, psychometric thresholds, and secondary surgeries. Secondary surgery in our study was defined as any open or arthroscopic hip surgery secondary to the initial revision surgery. Forest plots were created for pre- and postoperative outcomes present in ≥3 studies. Heterogeneity was calculated using I 2 values. Results: Four studies, including 215 revision labral reconstructions and 115 revision labral repairs of the hips, were included in this systematic review. All studies were level 3 evidence, and study periods ranged between 2009 and 2019. Mean follow-up for the reconstruction and repair groups ranged from 26.3 to 36.6 months and 30.7 to 56.4 months, respectively. The mean age for the reconstruction and repair groups varied between 27 to 34.6 years and 27.5 to 30 years, respectively. Mean postoperative modified Harris Hip Scores for the reconstruction and repair cohorts ranged from 72.0 to 81.2 and 70.8 to 84.1, respectively (I 2 = 0%). Mean visual analog scale for pain scores for the reconstruction and repair cohorts ranged from 3 to 3.5 and 2.3 to 3.9 (I 2 = 33%). Overall secondary surgery rates ranged from 10.0% to 26.7% in the labral reconstruction cohort, compared with 10.0% to 50.0% in the labral repair cohort. One study reported superior outcomes in the revision labral repair group, with 3 studies finding no statistically significant difference in outcomes between the groups. Conclusion: Our systematic review showed that patients undergoing revision hip arthroscopy with labral reconstruction demonstrated significant improvement in postoperative outcome measures. Postoperative outcomes were similar to those of a benchmark control group of patients undergoing revision hip arthroscopy and labral repair. Labral reconstruction in the revision setting appears to be an effective treatment in clinically indicated patients.

Arthroscopic surgery is not superior to conservative treatment in knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trails.

BACKGROUND: Studies comparing the effectiveness of arthroscopic knee surgery and conservative treatment on knee osteoarthritis (OA) came up with inconsistent results. Systematic review on this topic still is still lacking. This systematic review and meta-analysis aimed to evaluate the effectiveness of arthroscopic knee surgery on knee OA, compared to conservative treatments. MATERIALS AND METHODS: Literature searches were performed in PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) published before on 1st July 2024. Studies comparing the effectiveness of arthroscopy and conservative treatments only on knee OA were included. Quality of included studies was evaluated by risk of bias 2 (ROB2). Long-term results in terms of pain relief, functional recovery and patients reported satisfaction were meta-analyzed to evaluate the therapeutic effectiveness. RESULTS: Ten studies were included in this review, among which only 1 was considered as low risk of bias. Five studies were involved in meta-analyses and no difference was found in therapeutic effectiveness of arthroscopic surgery and conservative treatment on knee OA, in the evaluation of VAS (p = 0.63), WOMAC (p = 0.38), SF-36 (p = 0.74) and patient satisfaction (p = 0.07). CONCLUSION: The evidence does not support the effectiveness of arthroscopic knee surgery compared to conservative treatments in knee OA.

A retrospective study of arthroscopic treatment for patients with bordline developmental dysplasia of the hip.

PURPOSE: Hip arthroscopy is effective in treating bordline developmental dysplasia of the hip (BDDH), but there are only a few clinical reports in China, and its postoperative failure rate is still a problem that cannot be ignored. The aim of this study was to analyze the clinical effect of hip arthroscopy in BDDH treatment in China and to explore the risk factors influencing the efficacy of hip arthroscopy in BDDH treatment. METHODS: All of 22 cases of BDDH treated with arthroscopy in our hospital from November March 2017 to February 2022 were analyzed retrospectively, including ten males and 12 females, with an average age of 34.7 ± 9.5 years (19-53 years). All patients underwent arthroscopic treatment with acetabular plasty, labral repair, femoral osteoplasty, and capsular plication. Visual Analogue Scale (VAS), modified Harris Hip Scores (mHHS), Hip Outcome Score-activities of Daily Living (HOS-ADL) and International Hip Outcome Tool-12 (iHOT-12) were measured before operation and at the follow-up, and statistical analysis was performed. The Minimum clinically significant difference (MCID) and Patient Acceptable Symptom State (PASS) were also obtained. RESULTS: 22 patients were followed up, and the follow-up time was ≥ one year, with an average of 21.4 ± 8.2 months. The VAS score decreased from 5.27 ± 1.58 points before surgery to 1.96 ± 0.92 points at the follow-up, and the difference was statistically significant (t = 9.05,P < 0.001). The mHHS score increased from 64.84 ± 13.58 points before surgery to 90.4 ± 10.11 points at the follow-up, and the difference was statistically significant (t=-7.07, P < 0.001). The HOS-ADL score increased from 68.92 ± 11.76 points before surgery to 88.91 ± 9.51 points at the follow-up, and the difference was statistically significant (t=-8.15,P < 0.001). The iHOT-12 score increased from 49.32 ± 12.01 points before surgery to 79.61 ± 15.89 points at the follow-up, and the difference was statistically significant (t=-7.66,P < 0.001). The MCID (mHHS) and MCID (HOS-ADL) were 81.8% and 77.3% respectively, and the PASS (mHHS) and PASS (HOS-ADL) were 86.4% and 72.7% respectively at the follow-up. CONCLUSION: Hip arthroscopy can achieve good short-term outcomes in the treatment of BDDH. LEVEL OF EVIDENCE: IV Therapeutic Study.

Olecranon Bone Autografting Combined with an Arthroscopic Approach for the Treatment Scaphoid Nonunion - An Important Technique for Wrist Surgeons.

Effective treatment of scaphoid pseudoarthrosis is critical to reduce the risk of progression to the potentially debilitating scaphoid nonunion advanced collapse including complications of persistent wrist joint instability, degenerative arthritis, decreased range of motion, chronic pain, and functional impairment. Both anatomic and fracture-related pathophysiology predispose patients to scaphoid nonunion, including limited retrograde blood flow, fracture location, and delay of appropriate treatment. Recent studies have demonstrated successful outcomes in treatment of scaphoid nonunions, with non-vascularized bone autograft, commonly from distal radius or iliac crest, as well as pedicled vascularized or free vascularized autograft with union rates varying from 84% to 100%. However, these surgical treatment options require large dissection, prompting a focused interest in minimally invasive arthroscopic options. Theoretically, minimally invasive technique mitigates against devitalizing scaphoid fracture fragments as well as damage to structures such as the joint capsule, ligaments, and already highly tenuous blood supply. Use of olecranon bone graft in combination with a minimally invasive arthroscopic technique and screw fixation is a reasonable option to minimize devitalizing the scaphoid fracture fragments and minimize damage to important soft-tissue structures.

Surgical Treatment of Anterior Glenohumeral Instability: A Historical Review.

BACKGROUND: Glenohumeral instability is a common pathology, particularly in young, active patients. METHODS: A narrative review was performed to describe the history of surgical treatments for anterior shoulder instability. RESULTS: Open surgical techniques were first described by Bankart in 1923. Techniques include both anatomic soft tissue repairs and nonanatomic procedures to provide constraint to motion and dislocation. Osseous techniques to address glenoid bone loss include both autograft techniques, such as the Latarjet procedure, or the use of various allografts. Technological advances, particularly arthroscopy, have continued to drive the evolution of treatments. The concept of the glenoid track has furthered our understanding of this pathology to guide appropriate treatment to reduce recurrence. CONCLUSIONS: Surgical treatment for anterior shoulder instability continues to evolve in an effort to restore function and prevent additional injury.

[Efficacy of transdermal lidocaine 5% patches in postoperative analgesia following knee arthroscopy]. / Efectividad del parche transdérmico de lidocaína 5% en la analgesia postoperatoria después de la artroscopía de rodilla.

INTRODUCTION: knee arthroscopy is a common orthopedic procedure associated with postoperative pain, so optimizing pain management is essential for patient recovery and satisfaction. Lidocaine, a local anesthetic with well-established safety profiles, offers a potential alternative to traditional analgesic methods. Research regarding lidocaine patches has been conducted in several types of surgeries (laparoscopy, gynecological surgery, prostatectomy, etc.) showing promising results for some. This study investigates the effectiveness of transdermal lidocaine 5% patches as a novel approach to postoperative analgesia after knee arthroscopy. MATERIAL AND METHODS: a randomized, single-blind, placebo-controlled trial was conducted with participants undergoing knee arthroscopy. Patients were divided into two groups: one receiving transdermal lidocaine 5% patches and the other a placebo, both along traditional postoperative pain management, and using opioid only in cases with moderate-severe pain. Pain scores, opioid consumption, and patient-reported outcomes were assessed at various postoperative intervals. RESULTS: there was a significant reduction in pain scores and opioid consumption in the lidocaine patch group compared to the placebo group. CONCLUSIONS: transdermal lidocaine 5% patches emerge as a promising adjunct to postoperative pain management in knee arthroscopy patients. Their ease of application, minimal side effects, and opioid-sparing effects contribute to a multifaceted analgesic approach. This study underscores the potential of transdermal lidocaine patches in enhancing the overall postoperative experience for knee arthroscopy patients, advocating for their consideration in clinical practice.

INTRODUCCIÓN: la artroscopía de rodilla es un procedimiento ortopédico común asociado con dolor postoperatorio, por lo que optimizar el manejo del dolor es esencial para la recuperación y la satisfacción del paciente. La lidocaína, un anestésico local con perfiles de seguridad bien establecidos, ofrece una alternativa potencial a los métodos analgésicos tradicionales. Se ha llevado a cabo investigación sobre los parches de lidocaína en diversos tipos de cirugías (laparoscopía, cirugía ginecológica, prostatectomía, etcétera), mostrando resultados prometedores en algunos casos. MATERIAL Y MÉTODOS: se realizó un ensayo clínico aleatorizado, ciego simple y controlado con placebo que incluyó participantes sometidos a artroscopía de rodilla. Los pacientes fueron divididos en dos grupos: uno recibió parches transdérmicos de lidocaína al 5% y otro un placebo, ambos junto con el manejo tradicional del dolor postoperatorio y utilizando opioides sólo en casos de dolor moderado a severo. Se evaluaron las puntuaciones de dolor, el consumo de opioides y los resultados informados por los pacientes en varios intervalos postoperatorios. RESULTADOS: se registró una reducción significativa en las puntuaciones de dolor y el consumo de opioides en el grupo de parches de lidocaína en comparación con el grupo de placebo. CONCLUSIONES: los parches transdérmicos de lidocaína al 5% emergen como un complemento prometedor para el manejo del dolor postoperatorio en pacientes sometidos a artroscopía de rodilla. Su facilidad de aplicación, mínimos efectos secundarios y efectos ahorradores de opioides contribuyen a un enfoque analgésico multifacético. Este estudio destaca el potencial de los parches de lidocaína transdérmica para mejorar la experiencia postoperatoria general de los pacientes con artroscopía de rodilla, abogando por su consideración en la práctica clínica.

The relationship between the shape of rotator cuff tears and shoulder anatomical parameters.

BACKGROUND: The aim of this study is to investigate the potential relationship between shoulder anatomical parameters and the shape of rotator cuff tears (L-shaped, U-shaped, and crescent-shaped). MATERIALS AND METHODS: The study included 160 (n:160) patients. Patients were divided into four groups: crescent type, u type and L type tears and control group. There were 40 cases in each group. The operated patients were divided into three groups based on the shape of the tears in arthroscopic images. Measurements of Critical Shoulder Angle (CSA), Greater Tuberosity Angle (GTA), Acromion Index (AI), Lateral Acromion Angle (LAA), and Humerus Footprint width (coronal width and sagittal width) were taken in each group and compared. RESULTS: Patients were divided into four different groups: Crescent type group (n:40), L type group (n:40), U type group (n:40) and control group (n:40). Upon assessing the coronal and sagittal width measurements, The mean coranal width measurement of the L-type tear group was 12.62 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). The mean sagittal width of the L-type tear group was 34.95 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on GTA, CSA, and AI data, the mean GTA measurement of the L-type tear group was 73.03 ± 0.95 degrees, which was significantly higher than all other groups (p < 0.05). The mean CSA measurement of the L-type tear group was 34.77 ± 0.66 degrees, which was significantly higher than all other groups (p < 0.05). The mean AI measurement of the L-type tear group was 0.77 ± 0.02, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on LAA data, the mean LAA measurement of the L-type tear group was 76.98 ± 1.04 degrees, which was significantly lower than all other groups (p < 0.05). CONCLUSION: In our study, especially in L-shaped tears, measurements of GTA, CSA, AI, LAA, coronal and sagittal width were found to be different compared to the control group. These results suggest that shoulder anatomy affects the mechanisms of rotator cuff tear formation and that these parameters play a more significant role in L-shaped tears.

Arthroscopic treatment of temporomandibular dysfunction: preliminary results from a prospective follow up of over five years.

Patients with refractory temporomandibular dysfunction (TMD) despite conservative therapies often require surgical intervention. Although techniques such as arthrocentesis or arthroscopy have been established for years, there remains a dearth of evidence regarding the long-term efficacy of these interventions. This preliminary prospective study aims to elucidate the outcomes of arthroscopic treatment conducted over five years ago in patients with temporomandibular dysfunction. A study involving 31 patients with temporomandibular dysfunction who underwent level II arthroscopic surgery prior to 2019 is presented. The principal objective parameter for joint function was mouth opening, while the primary subjective parameters included pain, which was measured using the visual analogue scale (VAS), and quality of life, assessed using the OHIP-14sp questionnaire. Objective parameters were assessed preoperatively at one year and five years postoperatively, while quality of life was evaluated both preoperatively and five years after the procedure. Subsequently, the long-term status of patients was analysed, including surgical outcomes and the necessity for supplementary techniques such as second arthroscopy or open surgery. The quality-of-life scores significantly improved (p < 0.001) after five years of follow up when compared with preoperative assessments. Pain levels exhibited a statistically significant decrease over the follow-up period (p < 0.001). Significant differences were observed between preoperative and both 12-months' and five-years' follow up (both p < 0.001) but not between the 12-month and five-year marks (p = 0.899). Similar trends were noted for maximum mouth opening, with differences between pre-surgery and both 12-months' and five-years' follow up (p = 0.049 and p = 0.005, respectively) but not between the 12-month and five-year assessments (p = 0.482). Mouth opening at 12 months (p = 0.003) and five years (p = 0.032), as well as OHIP results at five years (p = 0.003), demonstrated statistically significant differences between groups according to the final status. In all cases, poorer clinical outcomes post-surgery (requiring a second arthroscopy or meniscectomy) correlated with decreased mouth opening and worse OHIP results. Arthroscopy emerges as an effective technique in the long-term treatment of temporomandibular joint dysfunction, as parameters such as pain and maximum mouth opening improve, and this improvement remains stable at the five-year follow up.

Chondral regeneration in femoroacetabular lesions is favoured using peripheral blood stem cells with hyaluronan-based scaffold and micro-drilling: A prospective cohort study.

Purpose: To determine whether intra-articular injections of peripheral blood stem cells (PBSC) with hyaluronan (HA)-based scaffold improve articular cartilage regeneration in chondral injuries caused by mixed-femoroacetabular impingement syndrome (FAIS) over a period longer than 24 months post-hip arthroscopy. Methods: In this prospective cohort study, patients with mixed-FAIS and chondral injury ≥ IIIB according to the International Cartilage Regeneration and Joint Preservation Society grade or III/IV of Konan/Haddad classification underwent intra-articular injection of PBSC with an HA-based scaffold and micro-drillings during hip arthroscopy. The degree of chondral repair was measured at baseline and 5 years using the International Cartilage Repair Society morphologic score system (MSS) as the primary outcome. Pain was measured at baseline and 5 years using the Visual Analogue Scale for Pain (VAS Pain), and hip functionality was measured at baseline (presurgery), 6 months, 1 year, and 5 years using the Hip Outcome Score (HOS). The largest diameter of injury, median follow-up, side effects, complications, and improvements were described. T-test, ANOVA with multiple comparisons, and statistical power were estimated. Results: From initially 34 cases, 25 patients were enrolled. The median follow-up was 5.1 ± 0.3 years. One patient (4%) reported a few side effects with filgrastim administration. No infection, tumours, or synovitis was reported. The largest diameters in zones two, three, and four were 12.4 ± 3.1 mm (n = 8), 13.5 ± 2.8 mm (n = 14), and 11.4 ± 1.9 mm (n = 3), respectively. Ninety-two percent (23/25) of patients improved their outcomes. The MSS and HOS increased from 3.8 ± 1.1 to 9.6 ± 1.5 pts (p < 0.001) and from 65.5 ± 13.0 to 93.9 ± 2.4 pts (p < 0.001), respectively. The VAS-Pain decreased from 5.3 ± 0.7 to 1.3 ± 0.6 mm (p < 0.001). The obtained a posteriori power-size was 0.99. Conclusion: The intervention suggests a favourable impact on articular cartilage regeneration and clinical outcomes for hip chondral lesions in mixed-FAIS injuries after a median follow-up of 5.1 ± 0.3 years. Level of Evidence: Level IV.

Borderline Developmental Dysplasia of the Hip With Osseous Impingement as Distinct From Femoroacetabular Impingement and Developmental Dysplasia of the Hip.

Background: Borderline developmental dysplasia of the hip (BDDH) accompanied by cam deformity and subspinous impingement has been found to benefit from arthroscopic surgery. However, the research comparing BDDH combined with osseous impingement to femoroacetabular impingement (FAI) without borderline dysplasia remains limited. Purpose/Hypothesis: To compare the clinical symptoms, intraoperative findings, and outcomes of hip arthroscopy in patients with BDDH and osseous impingement versus cam-type FAI. It was hypothesized that BDDH with osseous impingement could be classified as a distinct entity between FAI and developmental dysplasia of the hip (DDH). Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected from patients 18 to 50 years old who underwent primary hip arthroscopy between September 2016 and October 2020. Patients were divided based on preoperative lateral center-edge angle (LCEA) into 2 groups: (1) BDDH group (LCEA 18°-25°; n = 67); and (2) cam-type FAI group without BDDH (FAI group; LCEA 25°-40° and alpha angle >55°; n = 145). Disparities in symptoms, preoperative examination, intraoperative findings and procedures, and patient-reported outcome (PRO) scores were compared. Results: Follow-up was available for 61 (91.0%) patients in the BDDH group and 125 (86.2%) patients in the FAI group. The incidence of cam deformity in BDDH patients was 91.8%. The preoperative characteristics and intraoperative findings were similar between the groups; however, preoperative internal and external hip rotation, Tönnis angle, femoroepiphyseal acetabular roof index, labral size, capsule thickness, and percentage of ligamentum teres tear were significantly higher in the BDDH group than the FAI group, and the percentage of pain aggravating factor, cam deformity, and anterior inferior iliac spine types 2 and 3 were also significantly different between groups (P < .05 for all). The percentage of intraoperative minimal acetabuloplasty, subspinous decompression, labral repair, ligamentum teres debridement, and capsular closure was significantly higher in the BDDH group than the FAI group, while the percentage of femoroplasty was higher in the FAI group (P < .05). Pre- to postoperative improvement on PRO scores was seen in both groups. Conclusion: Given the differences in etiology and surgical procedures between the 2 conditions, it is suggested that BDDH with osseous impingement be classified as an entity distinct from FAI and DDH (and separate from BDDH without impingement) while excluding joint instability.

[Open surgical management of recurrent pigmented villonodular synovitis: case report and literature review]. / Manejo quirúrgico abierto de la sinovitis villonodular pigmentada recurrente: reporte de caso y revisión de literatura.

INTRODUCTION: pigmented villonodular synovitis (PVNS) is a benign condition that affects the knee, leading to abnormal proliferation of the synovial membrane and the accumulation of hemosiderin in the joint cavity. Although it can be surgically treated, PVNS tends to have a high recurrence rate, potentially resulting in chronic joint damage. CASE REPORT: we present the case of a young woman who experienced localized pain in her right knee due to a recurrence of PVNS. Magnetic resonance imaging revealed multiple multilobulated cystic lesions affecting the entire joint, including the ligaments. The patient underwent open surgical resection with a favorable clinical outcome. Histopathological examinations confirmed the absence of malignancy. CONCLUSION: while arthroscopy is typically the preferred treatment for PVNS, this case highlights the tendency for recurrence associated with this approach. Open surgical resection, supported by benign histopathological findings in this case, suggests a favorable long-term prognosis.

INTRODUCCIÓN: la sinovitis villonodular pigmentada (SVNP) es una enfermedad benigna que afecta la articulación de la rodilla, que causa una proliferación anormal de la membrana sinovial y la acumulación de hemosiderina en la cavidad articular. A pesar de que es posible tratarla mediante cirugía, la SVNP tiende a tener una alta tasa de recurrencia, lo que puede resultar en daño articular crónico. REPORTE DEL CASO: se presenta el caso de una mujer joven que experimentó dolor localizado en la rodilla derecha debido a una recurrencia de SVNP. La resonancia magnética reveló múltiples lesiones quísticas multilobuladas que afectaban a toda la articulación, incluyendo los ligamentos. La paciente fue sometida a una resección quirúrgica abierta, con una evolución clínica favorable. Los exámenes histopatológicos confirmaron la ausencia de malignidad. CONCLUSIÓN: aunque la artroscopía se considera el tratamiento de elección para la SVNP, este caso ilustra la tendencia a la recurrencia asociada con este enfoque. La resección quirúrgica abierta, respaldada por los hallazgos histopatológicos benignos en este caso, sugiere un pronóstico favorable a largo plazo.

Carbon savings associated with changing surgical trends in total knee arthroplasty in England: a retrospective observational study using administrative data.

BACKGROUND: Best practice pathways for common surgical procedures, including total knee arthroplasty (TKA), have the potential to improve patient outcomes and reduce carbon emissions. We aimed to estimate the reduction in carbon emissions due to changing trends in the care of patients undergoing TKA in England. METHODS: This was a retrospective analysis of Hospital Episode Statistics data from 1 April 2013 to 31 March 2022 on adults undergoing elective primary TKA in England. The carbon footprint for each patient was calculated using carbon factors for multiple steps in the pathway, including ipsilateral knee arthroscopies in the year preceding the TKA, outpatient attendances, the index TKA, revisions of the TKA performed within 180 days of the index procedure, length of hospital stay and emergency readmissions. RESULTS: A total of 648,861 TKA operations were identified. Over the study period, the median length of stay reduced from four to three days, the proportion of patients undergoing ipsilateral knee arthroscopies performed within a year before TKA surgery fell from 5.9% to 0.5% and the number of early revisions and emergency readmissions also fell. The per-patient carbon footprint reduced from 378.8kgCO2e to 295.2kgCO2e over this time. If all the study patients had the same carbon footprint as the average patient in 2021/2022, 32.4kilotons CO2e would have been saved, enough to power 29,509 UK homes for one year. CONCLUSIONS: Practices that were introduced primarily to improve patient outcomes can contribute to a reduction in the carbon footprint.

Outcomes of One-Stage Arthroscopic Ankle and Tibiotalocalcaneal Arthrodesis with External Fixation for Septic Ankle and Hindfoot Arthritis: A Case-Series Study.

OBJECTIVES: The occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study was to investigate the outcomes of one-stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis with external fixation in the treatment of septic ankle and hindfoot arthritis. METHODS: A retrospective consecutive case-series study was conducted involving six patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one-stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow-up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded. Comparisons of AOFAS ankle-hindfoot score and VAS pain score between preoperative measures and those at the final follow-up were conducted using paired t-tests or paired Wilcoxon rank-sum tests. RESULTS: The study cohort comprised two males and four females, with a mean age of 48.7 years (range, 26-75) at the time of surgical intervention. At the final follow-up (mean, 26.5 months; range, 16-48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12-57) to 80.0 (range, 54-92) (p = 0.007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4-9) to 0 (range, 0-5) (p = 0.046). All patients had achieved osseous consolidation, with a hindfoot infection control rate of 100%. CONCLUSION: One-stage arthroscopic ankle and TTC arthrodesis with external fixation is as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb.