Arthroscopic Decompression Research Articles

Arthroskopische Therapie bei spinoglenoidalem Ganglion

Aims and Indications A paralabral ganglion cyst of the shoulder can cause neuropathy of the inferior branches of the suprascapular nerve. This can lead to atrophy of the infraspinatus muscle. Arthroscopic decompression of the cyst in combination with repair of the associated labrum tear appears to be an effective treatment option. Methods Initially the connection of the cyst to the joint in the area of the posterior rim of the glenoid is identified arthroscopically. Following the decompression of the cyst the labrum tear is repaired to avoid recurrence. The goal is the complete decompression of the ganglion cyst carefully protecting the infraspinatus branch. Concomitant intraarticular pathologies are also addressed. Conclusions In the literature arthroscopic treatment is superior to open surgical treatments. The degree of muscle atrophy at the time of surgery determines the prognosis for functional recovery. There is a lack of long-term outcome studies and publications of larger case series.

Anterior Inferior Iliac Spine Morphology and Outcomes of Hip Arthroscopy in Soccer Athletes: A Comparison to Nonkicking Athletes

To describe the anterior inferior iliac spine (AIIS) morphology and clinical outcomes following arthroscopic surgical decompression in a group of high-level soccer athletes presenting with symptomatic hip impingement when compared with a control group of nonkicking athletes. From 2009 to 2012, we retrospectively reviewed our prospective hip registry for soccer athletes who underwent arthroscopic treatment for femoroacetabular impingement (FAI) with 2-year follow-up, comparing with a control group of nonkicking athletes. Demographics were collected and radiographic studies (plain radiograph and computed tomographic scan) reviewed for several parameters, including AIIS morphology. Patient-reported outcome scores, including modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool-33 (iHOT-33), were administered preoperatively, at 6months, and at 1, 2, and 3years postoperatively. Twenty-six soccer players (34 hips) and 87 nonkicking athletes (115) hips were identified. Demographics, including age (19.2 ± 4.1 vs 20.1 ± 3.8years) and gender distribution (53.8% vs 51.7% male), were similar between the soccer and nonkicking athletes (P= .288, .849). Eighty-four percent of soccer players demonstrated some abnormality of the AIIS extending to (type II, 52%) or below the anterior acetabular rim (type III, 32%), compared with 52% nonkicking athletes (P < .001). At a mean follow-up of 35months (range, 24-57months) there was significant improvement in all outcome scores in both groups from pre- to postoperation (P < .001). There was no evidence of differences in outcome scores between groups (mHSS: 89 ± 14.6 vs 88.2 ± 14.4, P= .804; HOS-ADL: 94.1 ± 9.1 vs 92.2 ± 11.1, P= .431; HOS-SSS: 86 ± 17.1 vs 81.3 ± 24.3, P= .362) with the exception of iHOT-33 (81.7 ± 19 vs 70.3 ± 23.6, P= .027). High-level soccer players have a significantly higher rate of subspine impingement compared with nonkicking athletes. There should be a high index of suspicion when treating soccer players for FAI, where appropriate recognition and treatment of subspine impingement can yield excellent clinical results. Level III, retrospective case-control study.

Injection de colorant carmin dans le traitement arthroscopique des kystes juxtaglénoïdiens de l’épaule

Paralabral cysts in the shoulder are a relatively rare pathology. It is sometimes difficult to detect the location of a paralabral cyst in the shoulder using arthroscopy, and it can be difficult to confirm sufficient decompression by arthroscopy. We describe the case of a 64-year-old woman who underwent arthroscopic decompression for a paralabral cyst in the shoulder. Indigo carmine was injected into the cyst under ultrasonography guidance just before the operation. The leakage point of indigo carmine was detected using arthroscopy. Arthroscopic decompression was performed until the indigo carmine was completely discharged. Her shoulder pain, limited range of motion, and muscle weakness during abduction and external rotation improved postoperatively. Magnetic resonance imaging confirmed the disappearance of the cyst. Arthroscopic decompression using an ultrasonography-guided injection of indigo carmine is a useful treatment for a paralabral cyst in the shoulder.

Arthroscopic Decompression of a Type III Subspine Impingement

Extra-articular hip impingement refers to a variety of hip disorders causing pain and limited function in young, non-arthritic patients. Recently, there has been an increased focus on analyzing the degree of anterior inferior iliac spine (AIIS) dysmorphism and its correlation with subspine impingement (SSI), defined as abutment between a prominent distal aspect of the AIIS and the anterior aspect of the femoral head-neck junction. Arthroscopic decompression of the AIIS is recognized as an effective treatment for SSI. However, there may be some inherent risks of performing this procedure arthroscopically that require further investigation.

Arthroscopic decompression with indigo carmine for treating paralabral cysts in the shoulder

Paralabral cysts in the shoulder are a relatively rare pathology. It is sometimes difficult to detect the location of a paralabral cyst in the shoulder using arthroscopy, and it can be difficult to confirm sufficient decompression by arthroscopy. We describe the case of a 64-year-old woman who underwent arthroscopic decompression for a paralabral cyst in the shoulder. Indigo carmine was injected into the cyst under ultrasonography guidance just before the operation. The leakage point of indigo carmine was detected using arthroscopy. Arthroscopic decompression was performed until the indigo carmine was completely discharged. Her shoulder pain, limited range of motion, and muscle weakness during abduction and external rotation improved postoperatively. Magnetic resonance imaging confirmed the disappearance of the cyst. Arthroscopic decompression using an ultrasonography-guided injection of indigo carmine is a useful treatment for a paralabral cyst in the shoulder.

Peculiar Problems Affecting the Sciatic Nerve.

Most insults to the sciatic nerve arise from intervertebral disc conditions or spinal stenosis. However, beyond these common etiologies for sciatic-nerve problems are a host of other, rarer causes. This month’s “Case Connections” explores 4 such peculiar examples. In the October 12, 2016, edition of JBJS Case Connector, Lee et al. reported on 3 patients who had persisting sciatica due to entrapment neuropathy caused by acetabular paralabral cysts. All 3 patients were managed successfully with arthroscopic decompression. The 2 men and 1 woman (mean age, 46.3 years) presented with radiating pain to the posterior aspect of the lower extremity, plus foot soreness or numbness. The symptoms had begun at a mean of 18 months prior to presentation but recently had become aggravated. None of the patients had range-of-motion limitations, but all had tenderness of the sciatic notch. In all 3 patients, MRI showed compression of the sciatic nerve by a perineural cyst arising from a paralabral cyst (Fig. 1) that extended into the greater sciatic foramen. Imaging showed no other abnormalities of the lumbar spine in any of the patients. Fig. 1 Axial MRI showing a paralabral cyst forming a perineural cyst around the sciatic nerve (arrow). All patients underwent arthroscopic decompression, during which surgeons incised and drained the perineural cysts by cutting in the same direction as the nerve with an arthroscopic knife. Surgeons observed drainage from all the perineural cysts after decompression, and postoperatively, all patients experienced marked reductions in pain. Two patients reported complete relief after a mean postoperative follow-up period of 52 months. The third patient reported partial relief, with some persistent mild pain and hypoesthesia. MRI scans that were made 2 years after surgery showed either no evidence of perineural cyst recurrence or only a small, clinically insignificant remnant. While Lee et al. conceded that “total …

Arthroscopic Decompression Of Sciatic Neuropathy Caused By Cysts Arising From Hip Joint

Arthroscopic Decompression Of Sciatic Neuropathy Caused By Cysts Arising From Hip Joint

Valgus Extension Overload: Arthroscopic Decompression in the Supine-Suspended Position

Elbow arthroscopy is a useful tool for managing diseases of the elbow, including valgus extension overload, when conservative treatments have failed. Arthroscopic access to the elbow in the supine-suspended position is simple and reproducible with the technique described in this report. Synovial tissue can be cleared, optimizing visualization of the anatomic structures in the elbow including the posterior ulnohumeral joint. This report describes, in detail, arthroscopy of the elbow in the supine-suspended position and basic principles for arthroscopic decompression of the posterior elbow for valgus extension overload.

Outcomes of Arthroscopic Decompression of Spinoglenoid Cysts Through a Subacromial Approach

To describe a spinoglenoid cyst decompression technique through a subacromial approach and its clinical outcomes after 2years of follow-up. From March 2008 to October 2013, 26 patients underwent arthroscopic decompression of a spinoglenoid ganglion cyst with and/or without superior labral anterior to posterior repair, and patients who were available for minimum of 2years of follow-up were included. For functional assessments, the visual analog scale (VAS) pain score, subjective shoulder value (SSV), University of California at Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeon (ASES) score, and shoulder active range of motion were used to compare preoperative and postoperative follow-up values. Follow-up magnetic resonance arthrography was taken at 6months postoperatively to evaluate incomplete decompression or recurrence of the cyst. In total, 21 patients were included in this study. At the 2-year follow-up, the VAS, SSV, ASES, and UCLA shoulder scores significantly improved compared with preoperative values (P < .001): VAS improved from 3.5 to 0.7 (P < .001); SSV improved from 62.9 to 93.1 (P < .001); ASES score improved from 64.3 to 94.4 (P < .001); UCLA shoulder score improved from 21.6 to 32.9 (P<.001). Also, active forward flexion improved from 153° to 158° (P= .014), and external rotation improved from 55° to 57° (P= .042) significantly, with the exception of internal rotation. The follow-up magnetic resonance arthrography was performed in 18 patients (86%), and there was no recurrence of the spinoglenoid notch cyst. For spinoglenoid cyst decompression, the subacromial approach was found to be effective, yielding satisfactory clinical outcomes without recurrence. Level IV, therapeutic case series.

Arthroscopic Central Acetabular Decompression: Clinical Outcomes at Minimum 2-Year Follow-up Using a Matched-Pair Analysis

To assess 2-year clinical outcomes of patients who underwent hip arthroscopy for central acetabular osteophytes (CAO) treated with central acetabular decompression (CAD), and to compare these outcomes with those of a matched control group. Data were prospectively gathered for patients undergoing CAD during hip arthroscopy from February 2008 to July 2012. All patients were assessed pre- and postoperatively at 3months, 1year, and 2years with modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, and visual analog scale (VAS) for pain. Patient satisfaction (0 to 10) was collected. A matched control group of patients without CAOs who did not undergo CAD was selected on a 1:3 ratio. Forty-nine hips were included in the CAD group and 147 in the control group. The mean change in patient-reported outcome (PRO) scores at 2-year follow-up in the CAD group for modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport-Specific Subscale, Non-Arthritic Hip Score, and VAS was 11.0, 19.6, 15.2, 21.4, and-2, respectively. The mean change in PRO scores at 2-year follow-up in the control group was 17.0, 19.8, 24.0, 20.9, and-2.75, respectively. All improvements in PRO scores for both groups were statistically significant compared with the data collected preoperatively (P < .001). There was no statistically significant difference in postoperative PRO scores and VAS between the groups. Postoperative patient satisfaction at the latest follow-up was 7.14 and 7.60 for CAD and control groups, respectively. This study showed that patients with a CAO treated with CAD during hip arthroscopy had favorable outcomes at minimum 2years postoperatively. Furthermore, the study group showed similar PRO scores and VAS to the control group. We conclude that CAD is a viable treatment option for CAO, yielding clinical improvement at short-term follow-up. Level III, prospective comparative study.

Arthroscopic management of popliteal cysts.

Background:Management of popliteal cyst is controversial. Owing to high failure rates in open procedures, recent trend is towards arthroscopic decompression and simultaneous management of intraarticular pathology. We retrospectively analysed clinical results of symptomatic popliteal cysts after arthroscopic management at 24 month followup.Materials and Methods:Retrospective analysis of hospital database for patients presenting with pathology suggestive of a popliteal cyst from June 2007 to December 2012 was done. Twelve cases of popliteal cyst not responding to NSAIDS and with Rauschning and Lindgren Grade 2 or 3 who consented for surgical intervention were included in the study. All patients underwent arthroscopic decompression using a posteromedial portal along with management of intraarticular pathologies as encountered. Furthermore, the unidirectional valvular effect was corrected to a bidirectional one by widening the cyst joint interface. The results were assessed as per the Rauschning and Lindgren criteria.Results:All patients were followed for a minimum of 24 months (range 24-36 months). It revealed that among the study group, six patients achieved Grade 0 status while five had a minimal limitation of range of motion accompanied by occasional pain (Grade 1). One patient had a failure of treatment with no change in the clinical grading.Conclusion:Arthroscopic approach gives easy access to decompression with the simultaneous management of articular pathologies.

Unusual Presentation of Popliteal Cyst on Magnetic Resonance Imaging.

Popliteal cyst commonly presents as an ellipsoid mass with uniform low signal intensity on T1-weighted magnetic resonance images and high signal intensity on T2-weighted images. Here, we describe a popliteal cyst with unusual appearance on magnetic resonance imaging, including heterogeneous intermediate signal intensity on T2-weighted images. Arthroscopic cyst decompression revealed that the cyst was filled with necrotic synovial villi, indicative of rheumatoid arthritis. Arthroscopic enlargement of unidirectional valvular slits with synovectomy was useful for the final diagnosis and treatment.

Supraspinatus Unusual Atrophy Pattern: A Case Report

We present the case of an unusual atrophy pattern of the supraspinatus muscle subsequent to suprascapular nerve compression by a paralabral cyst located in the spinoglenoid notch. A 58-year-old right-handed manual female worker presented to a specialized shoulder consultation with severe progressive pain in her right shoulder. Clinical exam revealed isolated limitation in active abduction and a painful Jobe test. MR-arthrogram showed a 12 × 10 mm paralabral cyst consecutive to a superior labral anterior to posterior (SLAP) II lesion, associated with an isolated supraspinatus Thomazeau stage II atrophy and Goutallier stage II fatty infiltration. A rotator cuff tear was excluded. After a failed nonoperative management, the patient underwent arthroscopic cyst decompression, SLAP debridement and biceps tenodesis, and presented satisfactory pain relief at 12 months follow-up with a constant score of 76 points. A control MR-arthrogram showed no recurrence of the cyst with regression of atrophy to stage I. In addition to confirm the known association between SLAP lesions and paralabral cysts, and to support the debated reversibility of atrophy, this presented case reveals the existence of a new type of lesion induced by suprascapular nerve compression, consisting in isolated denervation of the supraspinatus muscle. This can be explained by an anatomic variation of the supraspinatus branch of the nerve which had an unusually distal origin, whereas typical compression patterns involve either supraspinatus and infraspinatus, or infraspinatus alone.

SLAP repair with arthroscopic decompression of spinoglenoid cyst.

Introduction: A spinoglenoid cyst with suprascapular nerve disorders is highly associated with superior labrum anterior posterior (SLAP) lesion. Conservative or surgical treatment is applied to relieve pain and neurological symptoms. The purpose of this study was to evaluate clinical outcomes of patients treated by arthroscopic surgery for SLAP lesion with a spinoglenoid cyst. Methods: The subjects of this study were six patients with SLAP lesion with a spinoglenoid cyst who underwent arthroscopic surgery. There was one female and five males with a mean age of 48.5 years. SLAP lesion was found in all the patients at arthroscopy. A small tear of the rotator cuff was found in the two patients. The SLAP lesion was repaired using suture anchors, and the rotator cuff tears were repaired by suture-bridge fixation. The spinoglenoid cyst was decompressed through the torn labrum in three patients, and through the released superior to posterior portion of the capsule in the other three patients. Results: All patients showed excellent improvement in pain and muscle strength at the final follow-up examination. The mean Constant score was improved from 60.5 points preoperatively to 97.2 points postoperatively. The mean visual analog scale (VAS) score decreased from 4.5 on the day of the surgery to 2.5 within one week postoperatively. Postoperative MRI showed disappearance or reduction of the spinoglenoid cyst in four and two patients, respectively. There were no complications from the surgical intervention and in the postoperative period. Discussion: The patients treated by decompression through the released capsule obtained pain relief at an early period after the surgery. Arthroscopic treatment for a spinoglenoid cyst can provide a satisfactory clinical outcome. Arthroscopic decompression of a spinoglenoid cyst through the released capsule is recommended for a safe and reliable procedure for patients with suprascapular nerve disorders.

Arthroscopic Decompression of an Inferior Paralabral Cyst of the Shoulder in an Elderly Patient: A Case Report

The widespread use of diagnostic radiography, especially using magnetic resonance imaging, has helped to increase the diagnosis of paralabral cysts in patients with chronic shoulder pain. These paralabral cysts are frequent in the anterior, the superior, and the posterior compartment of the shoulder joint but are rare in the inferior compartment. Paralabral cysts in the shoulder appear particularly in men in their third and fourth decades but rarely in elderly patients. We report a case of an inferior paralabral cyst in an elderly patient whom we treated through arthroscopic decompression. (Clin Shoulder Elbow 2015;18(4):266-268) ed without particular trauma from a month before. Specifically, he complained of pain around the posterior compartment of the shoulder, and without particular reason he complained that the pain exacerbated at night. At the time of admittance, the patient scored a visual analogue scale for pain of 6 points. Through physical examination, we found that the range of motion of the left shoulder showed a forward elevation of 160 o , an external rotation of 40 o , an internal rotation of 40 o , and an abduction of 120 o ; the patient displayed slight restriction in motion. We did not observe other physical or neurological abnormalities that indicated instability. Visually, we could not find evidence for atrophy of the muscles, and muscle strength was within the nor- mal range. Because symptoms prevailed with drug therapy, we carried out plain radiography and MRI. At the preoperative MRI, we found and diagnosed a ganglion cyst, which was fused to the articular surface, with a dimension of 2.5×1.5×2 cm at the inferior labrum, and an inferior labral tear (Fig. 1). Despite con- servative treatment of the paralabral cyst through drug therapy, rest, and modified activity for 3 months, the symptoms did not improve; thus, we decided to treat the patient surgically. Under general anesthesia, we placed the patient in the right

Arthroscopic Scapulothoracic Decompression for Snapping Scapula Syndrome

Snapping scapula syndrome at the superomedial corner of the scapula can lead to significant shoulder dysfunction. Bursectomy with or without partial scapulectomy is currently the most beneficial primary method of treatment in patients in whom nonoperative therapy fails. Arthroscopic access to the scapulothoracic space is simple and reproducible with the technique described in this report. The bursal tissue can be cleared, optimizing visualization of the scapulothoracic space and the anatomic structures. Arthroscopic decompression of the scapulothoracic bursa and resection of the superomedial corner of the scapula are highlighted in a video example.

Endoscopic Ganglionectomy of the Elbow

Resection of the ganglion of the elbow is indicated if the size or location of the cyst impairs function or causes significant pain. Arthroscopic decompression or endoscopic resection of the cyst is the minimally invasive surgical option. It has the potential advantage of better cosmetic results and less soft-tissue dissection. Endoscopic resection is indicated if the cyst is not communicating with the joint or the communication is not identifiable arthroscopically or if there is a long and narrow communication placing the cyst away from the elbow joint. Preoperative magnetic resonance imaging is essential for surgical planning.

Effect of Subspine Decompression on Rectus Femoris Integrity and Iliopsoas Excursion: A Cadaveric Study

To determine the relative influence of anteroinferior iliac spine (AIIS) or subspine decompression on proximal rectus femoris integrity and iliopsoas excursion throughout a physiological range of motion. Nineteen cadaveric hips from 10 specimens were dissected to retain the origin of the rectus femoris direct and indirect heads. The anatomic footprints of the origins were measured with calipers. Serial 5-mm resections of the AIIS were made to determine the extent of proximal tendon disruption that corresponded to each resection. Iliopsoas tendon tracking was also assessed after sequential AIIS decompression by measuring the excursion of the medial border of the iliopsoas tendon as it traveled from its native resting position to the point where it first encountered bony impingement at the AIIS. The mean proximal-distal footprint of the rectus femoris direct head was 17.95 ± 2.99 mm. The mean medial-lateral distance was 11.84 ± 2.34 mm. There was a consistent bare area along the inferior aspect of the AIIS that averaged 4.84 ± 1.42 mm. The average percentage of remaining footprint after each 5-mm resection (5 to 25 mm) was96%, 65%, 35%, 14%, and 11%, respectively, with statistical significance noted after resections larger than 5 mm (P< .001). The native excursion distance of the iliopsoas tendon was 14.05 mm. With each 5-mm resection, the percentage of excursion before impingement on the AIIS increased by 18%, 45%, 72%, 95%, and 100%, respectively, which was statistically significance after all resections (P < .001). Our study maps the anatomic footprint of the direct head of the rectus femoris tendon and confirms a previously identified bare area along the inferior aspect of the AIIS. Female cadaveric hips had a significantly smaller rectus footprint than male cadavers in our study (P < .001). Subspine decompression greater than 10 mm significantly compromises the rectus femoris origin and should be avoided when performing arthroscopic AIIS decompression. In addition, subspine decompression significantly improves tracking of the iliopsoas tendon throughout a physiological range of motion and may be considered a surgical adjunct when treating symptomatic iliopsoas snapping. Arthroscopic subspine decompression serves as an important treatment modality for AIIS impingement. With a more thorough understanding of AIIS anatomy, subspine decompression can be used to relieve impingement symptoms and possibly improve iliopsoas tracking while safely maintaining rectus femoris footprint integrity.

Direct “Cystoscopic” Approach for Arthroscopic Decompression of an Intraosseous Ganglion of the Lunate

Intraosseous ganglion cysts (IOGs) are uncommon lesions of the carpal bones and can present with persistent pain and stiffness of the wrist. Surgical decompression is recommended, and a variety of approaches to decompress symptomatic IOGs of the wrist have been described. We describe an arthroscopic approach that can be performed with only 2 portals and offers excellent access for visualization and instrumentation. The procedure involves creating a 3.2-mm tunnel into the lunate cyst; this is performed through the dorsal non-articular surface of the lunate, under direct vision, and the position is confirmed with fluoroscopy. A 2.4-mm arthroscope is passed through the drill hole, and a direct “cystoscopic” view of the IOG is obtained. Biopsy of the cyst contents is performed under direct vision, and small-joint shavers and burrs are used for effective debridement. Advantages of this technique are actual visualization of the pathology, complete intracystic debridement, and simultaneous treatment of any coexistent intra-articular pathology. In addition, the minimal 3.2-mm lunate tunnel access maintains the structural integrity of the lunate and reduces the need for additional bone graft supplementation.

Arthroscopic decompression of paralabral cyst around suprascapular notch causing suprascapular neuropathy.

A case of 22 year old male gymnast, who suffered from suprascapular neuropathy due to compression of suprascapular nerve by paralabral cysts around suprascapular notch, leading to marked atrophy of supraspinatus and infraspinatus muscles. After arthroscopic decompression of paralabral cysts, weakness and atrophy of the supraspinatus and infraspinatus muscles improved.