Assistance Of Arthroscopy Research Articles

Arthroscopy assistance in the surgical management of distal radius fractures does not result in superior radiological and functional outcomes: A systematic review and meta-analysis of randomized controlled trials.

To evaluate the efficacy of assistant arthroscopy in the surgical treatment of distal radius fractures (DRFs) by the functional and radiological outcomes between the arthroscopic and control groups. We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for studies that compared the clinical outcomes of patients who underwent surgery with or without adjuvant arthroscopy. After screening the studies, we identified six randomized controlled trials. We analyzed radiological outcomes, range of motion, functional scores, grip strength, operative time, and complication rates. The standardized mean difference (SMD) was used to analyze differences in outcomes between the two groups. Statistical significance was set at p < 0.05. Six studies involving 455 patients were included. The findings of this analysis indicate that the utilization of arthroscopic assistance did not yield superior radiological outcomes and functional outcomes, except in radial deviation (SMD = 0.96; 95% CI = 0.36, 1.55; I2 = 69%) and ulnar deviation (SMD = 0.69; 95% CI = 0.38, 1.00; I2 = 16%). In addition, the arthroscopic group exhibited longer operation time (SMD = 0.65; 95% CI = 0.1, 1.2; I2 = 81%) compared to the control group. There were no significant differences in the grip strength or complication rates between the two groups. The findings of this analysis indicate that arthroscopy-assisted surgery for DRF does not yield significantly enhanced outcomes in terms of radiological outcomes, functional scores, grip strength, and complications, even though range of motion (radial deviation and ulnar deviation) were superior in the arthroscopically assisted cases. Given the extended operational time associated with adjuvant arthroscopy, the efficacy of assistant arthroscopy in the surgical management of distal radius fractures with joint involvement is not justified. Level II, meta-analysis of Level I and Level II studies.

Contribution of arthroscopy to the treatment of intraarticular fracture of the distal radius: Retrospective study of 40 cases

Our study aimed to compare the anatomical result after treatment of intraarticular distal radius fracture with locking volar plates with and without arthroscopy. This was a retrospective, single-center study of intraarticular fractures. A volar locked plate was used for fracture fixation in all patients. Twenty patients were operated on with fluoroscopy only (“plate” group) and 20 operated using arthroscopy assistance (“arthroscopy” group). All patients underwent a CT scan before surgery and at 3 months postoperative. The main outcome measure was the residual intraarticular step-off (measured in millimeters). Other studied outcomes were the residual gap between fragments and extra-articular reduction. The two groups were similar preoperatively in all aspects except the size of the gap between fragments. The residual step-off was significantly less in the arthroscopy group: 1.9mm (Q1 1.7; Q3 2.25) for plate versus 0.8mm (Q1 0.7; Q3 1.5) for arthroscopy (P=0.001). The change from the preoperative to the postoperative measurement was significantly greater in the arthroscopy group: 0.1 mm (Q1 −0.5; Q3 0.8) for plate and −1mm (Q1 −1.9; Q3 −0.6) for arthroscopy (P=0.0002). The residual gap was similar between both groups: 2.4mm (Q1 1.9; Q3 3.5) for plate vs. 2.3mm (Q1 1.1; Q3 2.8) for arthroscopy (P=0.37). The change in gap was not significantly different between the two groups: −0.9mm (Q1 −1.8; Q3 −0.1) for plate vs. −2.9mm (Q1 −4.4; Q3 −1.7) for arthroscopy (P=0.32). There was no difference in the extra-articular reduction. Damage was found to the scapholunate ligament in 30% and the TFCC in 30% of arthroscopy cases. Arthroscopy improves intraarticular reduction without altering extra-articular reduction in patients with intraarticular fractures of the distal radius, and it allows for assessment and treatment of any injuries discovered. We must now follow these patients over the long-term to assess the clinical benefit. Level of evidence3.

Apport de l’arthroscopie en complément de l’ostéosynthèse des fractures articulaires de l’extrémité distale du radius. Étude prospective à propos de 40 cas

The purpose of our study was to compare the treatment of intra-articular distal radius fracture with locking volar plates with and without arthroscopy. We compared short-term clinical and functional recovery between the two groups. This was a retrospective, single-center study of intra-articular fractures. A volar locked plate was used for fracture fixation in all patients. Twenty patients were operated with fluoroscopy only- “plate” group and 20 operated using arthroscopy assistance “arthroscopy” group. All patients underwent a CT scan before surgery and at 3 months postoperative. The main outcome measure was the residual intra-articular step-off (measured in millimeters). Other outcomes were the residual gap between fragments, extra-articular reduction and functional and clinical recovery. The two groups were similar preoperatively in all aspects except the gap between fragments. The residual step-off was significantly less in the arthroscopy group- 1.9 mm (Q1 1.7 + Q3 2.25) for plate versus 0.8 mm (Q1 0.7 + Q3 1.5) for arthroscopy (P = 0.001). The change from the preoperative to the postoperative measurement was significantly greater in the arthroscopy group- 0.1amm (0.5 + Q3 0.8) for plate and ±1 mm (Q1 ±1.9 + Q3 -0.6) for arthroscopy (P = 0.0002). The residual gap was similar between both groups- 2.4 mm (Q1 1.9 + Q3 3.5) for plate versus 2.3 mm (Q1 1.1 + Q3 2.8) for arthroscopy (P = 0.37). The change in gap was not significantly different between the two groups- ± 0.9 mm (Q1 ± 1.8 + Q3 ± 0.1) for plate versus ± 2.9 mm (Q1 -4.4 + Q3 ± 1.7) for arthroscopy (P = 0.32). There was no difference in the extra-articular reduction. Damage was found to the scapholunate ligament in 30% and the TFCC in 30% of arthroscopy cases. Arthroscopy improves intra-articular reduction without altering extra-articular reduction in patients with intra-articular fractures of the distal radius and it allows for assessment and treatment of any injuries discovered.

Open surgery assisted with arthroscopy to treat synovial chondromatosis of the temporomandibular joint

Open surgery and arthroscopy for the treatment of synovial chondromatosis (SC) of the temporomandibular joint (TMJ) have their advantages and disadvantages. The aim of this study was to report the application and results of the combined use of these two methods in the treatment of SC and the indications for use. A total of 36 patients with magnetic resonance imaging (MRI) confirmation of SC, treated from 2010 to 2015, were included. Patients with tumours in the upper articular cavity and with the extended margin of the medial groove still in-between the medial crest of the condyle and infratemporal space on coronal MRI were selected to undergo open surgery with the assistance of arthroscopy to clear the loose bodies and affected synovium. All 36 patients first went through open surgery. Subsequent arthroscopy examinations indicated the presence of loose bodies in the medial groove in 14 patients (in the anterior or posterior recess), which were removed using a cup-shaped clamp. Thirty-three of the patients were followed up for an average of 33.3 months; there was no recurrence in these patients. This technique has the benefits of the complete elimination of diseased tissues with a minimal osteotomy and a short surgical duration.

Comparative Study of Surgical Treatment of Articular Fractures of the Distal Radius With Volar Locking Screw Plate System in Patients With Workers Compensation

Background: Distal articular radius fractures occur in general in patients at middle age and who are occupationally active. The objective is to evaluate the usefulness of arthroscopy assistance on the reduction and fixation with volar locking screw system in articular fractures of the distal radius in patients with workers compensation. Materials and methods: Retrospective and descriptive study of 53 patients with a mean age of 47.1 years (20-77 years) who underwent surgery in a period of 1 year. The mean age of the 37 patients in the control group was 46.1 years (20-64 years), and the mean age of the 16 patients in the arthroscopic assistance group was 49.5 years (28-77 years). The patients were matched according to several variables: age, sex, type of fracture (according to the Arbeitsgemeinschaft für Osteosynthesefragen [AO] classification), time between the accident and the surgery, number of reoperations and the time of labor reinsertion (discharge) quantify as days off with medical leave. Results: The groups were comparable because there were no significant differences in the variables studied. The mean age of the control group was 46.1 years and the arthroscopy group was 49.5 years ( P = .3396, Student t test). Sex of control group was 22 males (59.5%) and 15 females (40.5%), and the arthroscopic group was 11 males (68.75%) and 5 females (31.25%), P =.522 (chi-square test). The type of fracture was B1-B2-C1-C2 and C-3. The arthroscopic group was type C1-C2-C3 ( P = .738, chi-square test). The time to surgery in control group was 11.9 days and in the arthroscopic group 12.1 days ( P = .9271, Student t test). Significant differences were shown in the time of labor reinsertion and in the numbers of reoperations. Time of labor reinsertion in the control group was 188.3 days (5.5 months) and in the arthroscopic group was 89.8 days (2.9 months), P = .00025, Student t test. The number of reoperations in the control groups was 13 (35.14%) and in the arthroscopic group was 1 (6.25%), P = .000, chi-square test. Conclusion: Patients with articular distal radius fractures with workers compensation treated with a volar locking screw plate system and arthroscopic assistance show less number of reoperation and less time to labor reinsertion compared with patients who underwent the same surgery without arthroscopic assistance.

Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury.

Background:Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair.Materials and Methods:Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013. These patients were followed up for an average of 19 months (range 14–25 months). The avulsed TFCC were reattached to the fovea using a transosseous pull-out suture or a knotless suture anchor. At the final followup, the range of motion, grip strength and DRUJ stability were measured as objective outcomes. Subjective outcomes were assessed using the Visual Analog Scale (VAS) for pain, patient rated wrist evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score) and return to work.Results:Based on the DRUJ stress test, 5 patients had normal stability and 7 patients showed mild laxity as compared with the contralateral side. Postoperatively, the mean range of pronation supination increased from 141° to 166°, and the mean VAS score for pain decreased from 5.3 to 1.7 significantly. The PRWE and DASH questionnaires also showed significant functional improvement. All patients were able to return to their jobs. However, two patients complained of persistent pain.Conclusions:Arthroscopically assisted repair of TFCC foveal injury can provide significant pain relief, functional improvement and restoration of DRUJ stability.

Arthroscopic-Assisted Combined Dorsal and Volar Scapholunate Ligament Reconstruction with Tendon Graft for Chronic SL Instability.

Background Both the dorsal and the volar portion of the scapholunate interosseous ligament (SLIL) are major stabilizers of the scapholunate (SL) joint. Most reconstruction methods to restore SL stability do not address the volar constraints and frequently fail to reduce the SL gapping. Wrist arthroscopy allows a complete evaluation of the SL interval, accompanying ligament status, and associated SL advanced collapse (SLAC) wrist changes. It enables simultaneous reconstruction of the dorsal and palmar SL ligaments anatomically with the use tendon graft in a boxlike structure. Materials and Methods From October 2002 to June 2012, the treatment method was applied in 17 patients of chronic SL instability of average duration of 9.5 months (range 1.5-18 months). There were three Geissler grade 3 and 14 grade 4 instability cases. The average preoperative SL interval was 4.9 mm (range 3-9 mm). Dorsal intercalated segment instability (DISI) deformity was present in 13 patients. Six patients had stage 1 SLAC wrist change radiologically. Concomitant procedures were performed in four patients. Description of Technique With the assistance of arthroscopy and intraoperative imaging as a guide, a combined limited dorsal and volar incision exposed the dorsal and palmar SL interval without violating the wrist joint capsule. Bone tunnels of 2.4 mm were made on the proximal scaphoid and lunate. A palmaris longus tendon graft was delivered through the wrist capsule and the bone tunnels to reduce and connect the two bones in a boxlike fashion. Once the joint diastasis is reduced and any DISI malrotation corrected, the tendon graft was knotted and sutured on the dorsal surface of the SL joint extra-capsularly in a shoe-lacing manner. The scaphocapitate joint was transfixed with Kirschner wires (K-wires) to protect the reconstruction for 6-8 weeks. Results The average follow-up was 48.3 months (range 11-132 months). Thirteen returned to their preinjury job level. Eleven patients had no wrist pain, and six had some pain on either maximum exertion or at the extreme of motion. The average total pain score was 1.7/20 compared with the preoperative score of 8.3/20. The postoperative average total wrist performance score was 37.8/40, with an improvement of 35%. The average extension range improved for 13%, flexion range 16%, radial deviation 13%, and ulnar deviation 27%. Mean grip strength was 32.8 kg (120% of the preoperative status, 84% of the contralateral side). The average SL interval was 2.9 mm (range 1.6-5.5 mm). Recurrence of a DISI deformity was noted in four patients without symptoms. Ischemic change of proximal scaphoid was noted in one case without symptoms or progression. There were no major complications. All patients were satisfied with the procedure and outcome. Conclusion Our method of reconstructing both the dorsal and volar SL ligament, in a minimally invasive way, is a logical and effective technique to improve SL stability. The potential risk of ischemic necrosis of the carpal bone is minimized by preservation of the scaphoid blood supply, the small size of the bone tunnels created, and the inclusion of the capsule at the reconstruction site.

Migration of bioabsorbable interference screw after anterior cruciate ligament reconstruction: A case report and literature review

Graft fixation using bioabsorbable interference screws in anterior cruciate ligament (ACL) reconstruction has become a common and standard procedure. Bioabsorbable implants are also referred to as biodegradable implants because they undergo hydrolytic degeneration. Complications are uncommon, and include cyst formation, abscess formation, fibroxanthoma, bone tunnel fracture, effusion, infection, screw breakage, and migration. Migration of bioabsorbable interference screws after ACL reconstruction is a rarely reported complication. Here, we present a case of intra-articular migration of femoral bioabsorbable screw. At arthroscopy, the whole femoral screw was observed lying in the intercondylar notch and completely removed under the assistance of arthroscopy. The symptoms resolved postoperatively at 1-year follow-up. Recognition and adequate management of bioabsorbable screw migration may prevent associated morbidities.

The arthroscopic diagnosis and treatment of acute patellofemoral joint impingement syndrome

Objective To explore the mechanism and characteristics of MRI of acute patellofemoral joint impingement syndrome as well as its arthroscopic diagnosis and treatment. Methods There were a total of 46 cases (9 males and 37 females) with acute patellofemoral joint impingement syndrome from September 2005 to October 2012 in our department, and their average age was 21.6 years old (ranging from 15 to 31 years old). The Q angle, lateral patellofemoral angle (LPA) and lateral shift distance(LSD) of all cases were measured by X-ray and MRI preoperatively. MRI checked the medial patellar retinaculum injury by 4 de-grees: 15 cases of degree Ⅰ, 18 cases of degree Ⅱ, 8 cases of degree Ⅲ, and 5 cases of degree Ⅳ. All operations were monitored under arthroscopy. Firstly, the hemarthrosis was cleared, and secondly arthroscopy was used to explore all around inside joints, the free cartilage and osteochondral fragment were taken out, and the impaired surface of cartilage was repaired. Medial patellar reti-naculum was treated arthroscopically with radio frequency ablation in degree Ⅰ injury. Lateral patellar retinaculum was released when the time of injury was longer than 2 weeks (9 cases), and medial capsule and retinaculum structure were reefed with modified arthroscopy assistance for patients with medial patellar retinaculum injury of degree Ⅱ to Ⅲ with obvious patellar shift. The medi-al capsule and retinaculum structure were strengthened by open surgical method for patients with degree Ⅳ injury. Results Constant findings under arthroscopy were haemarthrosis (46 cases), chondral lesions involved in the lateral femoral condyle and medi-al marginal of patella (37 cases), osteochondral fragments (28 cases), and tear of the medical retinaculum (46 cases). All patients were available at follow-up, the average duration of follow-up was 18.2 months (ranging from 12-36 months). No infection, nerve and blood vessel injury, redislocation or other complications happened. Lysholm, Tegner and AAOS scores were used both preoper-atively and postoperatively, and LPA and LSD were compared. Statistically, the difference between these two scores was significant (P<0.05). The sport ability was improved among all patients. Conclusion Acute patellofemoral joint impingement syndrome can be treated effectively by modified suture of medial capsule and retinaculum structure combined with release of lateral retinacu-lum. The function of knee joint recovered well after operation with satisfactory objective and subjective effects. Key words: Arthroscopy; Patellar; Wounds and injuries

Retrospective Evaluation of the Results of Arthroscopy Assisted Reduction and Osteosynthesis of Tibial Plateau Fractures and the Role of the Arthroscopy at Tibial Plateau Fractures

Objectives:Aim of this study is to compare the medium and long term functional and radiological results of 31 patients with tibial plateau fractures, treated by same surgeon with arthroscopy assisted reduction and osteosynthesis between 2006 and 2013.Methods:This study is designed as evaluation of retrospective case series. 52 patients who has administered Tepecik Education and Research Hospital or Private Izmir Hospital between 2006 and 2013 with tibial plateau fracture and treated by same surgeon with arthroscopic assisted reduction and osteosynthesis is evaluated. Patients with insufficient data and cannot continue follow-up are excluded. 31 patient is included to study meeting our criteria. Injury mechanism, physical examination findings, operation records, concomitant intra articular pathologies, need for allograft or autograft and radiological investigations are retrospectively obtained from hospital medical record system. Preoperative evaluation depends on Schatzker Classification. Patients with floating knee, ipsilateral tibia diaphysis fracture, distal femoral intraarticular fracture, compartment syndrome or neurovascular injury is excluded from study. We didn’t take Schatzker Class is not an exclusion criteria. Results are investigated with Rasmussen radiological and clinical scores statistically.Results:31 patients (23 male, 7 female) with mean age of 46,3 (min. 18- max. 67) is included our study with the mean follow-up of 45 months. Simultaneous meniscus lesion is detected in 15 patients and repair or partial meniscectomy is performed depending on the lesion. 10 patients need for allograft or autografting for joint surface restoration. Medial and/or lateral plate osteosynthesis is performed depending on fracture configuration. Final average Rasmussen functional score is calculated 25,7 and final average Rasmussen radiological score as 16,5. Secondary arthroscopic debridement is needed in 3 patients with arthrofibrosis.Conclusion:First arthroscopy assisted intra-articular fracture treatment is done in 1993 at knee joint and technique is improved with years. With the published satisfactory results of arthroscopy assisted series, current treatment of choice in tibial plateau fractures became arthroscopy assisted osteosynthesis, same as our routine application in our clinics. Advantages of arthroscopy is opportunity of treatment of concomitant intra articular pathologies, differentiation of these lesions as acute or degenerative and chronic more objective than any other imaging modality, detection of chondral injury more accurate and control of anatomical reduction of fracture lines. Downside of our study is lack of control group. Our conclusion is arthroscopy assistance in tibial plateau fractures improves results without increase in compartment syndrome or other complication rate when compared to literature.

Management of Scaphoid Fractures in the Athlete

Scaphoid fractures occur commonly in the athlete and should be treated with urgency to avoid undesired late complications. Magnetic resonance imaging may be helpful to make a prompt diagnosis so that an appropriate early treatment plan can be initiated. Cast immobilization in acute, nondisplaced scaphoid fractures seems to have an equivalent union rate to surgical modalities. Despite this, limiting the immobilization and time to union period in the athlete will allow earlier restoration of preinjury level function and eventual return to play. Percutaneous techniques with or without arthroscopy assistance have been advocated as less invasive surgical approaches that may have an added benefit in the athlete. Displaced and unstable fractures should be approached with a volar or dorsal open technique to achieve and confirm an anatomic reduction before screw placement.

Fractures of distal radius: an overview.

Fractures of distal radius account for up to 20% of all fractures treated in emergency department. Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. Treatment options include conservative management, internal fixation with pins, bridging and non-bridging external fixation, dorsal or volar plating with/without arthroscopy assistance. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed.

Arthroscopically assisted percutaneous osteosynthesis of displaced transverse patellar fractures with figure-eight wiring through paired cannulated screws

For treatment of displaced transverse patellar fractures, open reduction and internal fixation is the standard reconstructive method. The role of percutaneous osteosynthesis is still unclear and worth of further investigation. Our hypothesis is that satisfactory reduction and rigid fixation is possible for the treatment of displaced transverse patellar fractures with some percutaneous techniques. Here, we present and evaluate a minimally invasive technique for these patellar fractures. This is a retrospective study. Twenty-one patients with 21 transverse patellar fractures were treated with our percutaneous technique in acute phase. The minimally invasive surgery was achieved by closed reduction and fixation with modified Carpenter's technique, using figure-eight wiring through two parallel cannulated screws under the assistance of arthroscopy and fluoroscopy. The patients were followed up to an average of 38.8 months (range 26-48). Main outcome measurements included radiographic assessment, range of motion, Lysholm scores, complications, and reoperations. Radiographically, all fractures healed at a mean of 11.0 weeks (range 9-13). Mean total range of motion of knee joint was 140.1° (range 127-152). Functional assessment of Lysholm scores was 93.9 points (range 86-100). Malreduction, loss of reduction, and infection were not observed in 21 patients. Complications were three cases (14%) of hardware irritation, and needed a second operation for removal. Under the control of arthroscopy and fluoroscopy, we successfully treated 21 displaced transverse patellar fractures by percutaneously osteosynthesis. This is a safe and reproducible method for transverse patellar fractures. However, it is not indicated for severely comminuted fractures.