Results Of Arthroscopic Debridement Research Articles

OSTEOCHONDRAL AUTOLOGOUS TRANSPLANTATION VERSUS ARTHROSCOPIC DEBRIDEMENT WITH DRILLING IN THE TREATMENT OF TALAR OSTEOCHONDRAL LESIONS AND DEFECTS

The aim: To conduct a comparative analysis of the results of arthroscopic debridement with drilling (ADD) versus osteochondral autologous transplantation (OAT) in the treatment of talar osteochondral lesions and defects (OHLD) based on the assessment of the function of the ankle joint, the level of pain and changes in the range of movements (ROM) in the affected joint. Materials and methods: The study included 40 patients with OHLD, with an average area of 3.14 cm2 and a depth of 1.15 cm, located in the posterior and middle medial part of the talus block. In the group 1 performed ADD. In group 2 - OAT. The results were evaluated before surgery, at 12 and 24 months. The level of pain to VAS, the function to AOFAS, the ROM in the joint were studied. Results: After treatment, there was a significant reduction in pain with the best result in group 2 (p<0.05). AOFAS showed that after 12 and 24 months the functional state of the joint in group 2 was better than in group 1 (p<0.01). After 12 months, ROM increased significantly in both groups. After 24 months, there was no increase in ROM in group 1, and in group 2 the growth was statistically significant (p<0.01), which confirmed the higher prospects and stability of the result when performing OAT. Conclusions: OAT is better than ADD for talar OHLD, provides maximum recovery of the joint surface, significantly reduces pain and improves ankle function.

Management of mucoid degeneration of the anterior cruciate ligament: a systematic review

PurposeThe purpose of this study was to investigate the outcomes of management of mucoid degeneration of the anterior cruciate ligament (MDACL) by performing a systematic review of methods of treatment that have been reported.MethodsA systematic literature search in the databases MEDLINE, Embase, Google Scholar, Cochrane, ISI web of science and Scopus was performed through July 2020 by three independent reviewers. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42018087782). Quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.ResultsA total of nine studies were eligible for review. All nine studies assessed the outcome of arthroscopic debridement of MDACL. A total of 313 knees in 292 patients were included. The mean follow up ranged from 13 to 72 months. There was strong association between MDACL and chondral lesions (82%) and between MDACL and meniscal tears (69%). The rate of simultaneous meniscectomy ranged from 13 to 44%. Postoperative pain relief ranged from 53.8 to 95%. There was an improvement in postoperative range of motion and outcome scores (Lysholm and International Knee Documentation Committee scores and the Knee Injury and Osteoarthritis Outcome Score). Postoperative Lachman test was positive in 40% of patients, and 6% of patients had symptomatic instability. The mean MINORS score was 9.5 out of 16 (4–12).ConclusionsArthroscopic debridement of the anterior cruciate ligament (ACL) results in satisfactory pain relief and improvement in knee outcome scores. Postoperative ACL laxity is common after arthroscopic ACL debridement, however, symptomatic instability is not. The need for delayed ACL reconstruction should be discussed preoperatively, especially if complete resection of the ACL is to be performed.Level of evidenceIV

Arthroscopic Debridement and Arthrolysis for the Treatment of Advanced Kienböck's Disease: 18-Month and 5-Year Postoperative Results

Background Salvage procedures, such as proximal row carpectomy, limited or total wrist arthrodesis, and wrist replacement, are generally preferred to treat advanced Kienböck's disease. However, these procedures are particularly aggressive and may have unpredictable results and potentially significant complications. Questions/Purpose This study aimed to present the short- to mid-term clinical and functional results of arthroscopic debridement and arthrolysis in the management of advanced Kienböck's disease. Patients and Methods Fifteen patients in whom Lichtman Stages IIIA to IIIC or IV Kienböck's disease was diagnosed and treated by arthroscopic wrist debridement and arthrolysis were included in this retrospective study. The mean age was 30 years (range: 21-45). The mean follow-up period duration was 36 months (range: 18-60). The Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analog scale (VAS), wrist range of motion (ROM), and grip strength were measured preoperatively and then again at the final follow-up visit. Results The mean DASH and VAS scores improved from 41 (range: 31-52) and 7.1 (range: 6-8) preoperatively to 13 (range: 8-21) and 2 (range: 0-3; p < 0.001) at the final follow-up visit, respectively. The mean wrist flexion and extension values increased from 32 (range: 20-60 degrees) and 56 degrees (range: 30-70 degrees; p = 0.009) preoperatively to 34 (range: 10-65 degrees; p = 0.218) and 57 degrees (range: 30-70 degrees; p = 0.296) at the final follow-up appointment, respectively, although these findings were statistically insignificant. The mean strength of the hand grip increased from 22.7 (range: 9-33) to 23.3 (range: 10-34; p = 0.372). Conclusion Arthroscopic debridement and arthrolysis may improve wrist function and quality of life due to the preserved ROM and hand grip strength after short- to mid-term follow-up periods despite the radiographic progression of Kienböck's disease. Level of Evidence This is a Level IV, retrospective case series study.

Role of Arthroscopic Debridement of Hemophilic Ankles.

Arthroscopic debridement has been used in the treatment of early stages of hemophilic ankle arthropathy. The aim of this procedure is to alleviate pain, improve function, and diminish bleeding episodes. Evaluation of patient-reported outcomes of arthroscopic debridement for hemophilic ankle arthropathies was evaluated in this study. Fifteen patients with hemophilia who had undergone arthroscopic debridement between 2008 and 2017 were included in this study. Preoperative American Orthopaedic Foot & Ankle Society Score (AOFAS) and Foot Function Index (FFI) with its subscales were obtained. Patient-reported outcome was measured using FFI at the latest follow-up. Radiologic severity of hemophilic arthropathy was assessed with the Pettersson score. Preoperative and postoperative intraarticular bleeding frequencies of the hemophilic patients were compared. Patients experienced statistically significant improvements of FFI and its subscales. Median preoperative FFI scores dropped from 42.2% to 22.2% postoperatively. Median value for the Pettersson score was 3. Annual median bleeding frequency of the study group was 18 preoperatively and 1.5 postoperatively ( P = .002). By assessing patient-reported outcomes, pain and functional restrictions associated with hemophilic ankle arthropathy were improved following arthroscopic debridement. By means of subjective measures, this procedure was effective. Level IV, retrospective case series.

Arthroscopic debridement combined with microfracture for chronic enthesiopathy of achilles tendon

Objective To evaluate the efficacy of arthroscopic debridement combined with microfracture on management of chronic enthesiopathy of Achilles tendon. Methods Fifteen cases of chronic enthesiopathy of Achilles tendon were enrolled in this study from January 2013 to January 2016. There were 11 males and 4 females, with an average age of 55.5±8.9 years. Five were in left side, and 10 in right side. All the patients failed to recover after conservative treatments for 18 months to 10 years. Pathological tissue was eliminated by blade. Then microfracture was made. Arthroscopic awls (1.5 or 2 mm in diameter) were used for making multiple holes at the footprint of achilles tendon. These holes were made far enough (3-4 mm) apart so they do not break into each other. Fat droplets and bleeding from the marrow cavity were seen when the appropriate depth (approximately 5 to 10 mm) has been reached. The patients were evaluated preoperatively and postoperatively using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores and visual analogue scale (VAS) scores. Results Average operation time and length of stay were 30.6±15.4 min and 6.2±2.8 d, respectively. Postoperative incisions were I stage healing for all patients. There were no perioperative and postoperative complications related to the procedure, such as rupture of achilles tendon, blood vessel and nerve injury. No infection and recurrence was found in all cases. All patients were followed up for an average time of 13.5 months. No rupture of achilles tendon or relapsing symptom was found. Average VAS scores before surgery, 6 month after surgery and at the lattest follow-up were 7.3±1.6, 2.4±1.3, and 2.3±1.3, respectively. Average AOFAS Ankle-Hindfoot scores were 38.5±7.8, 92.9±6.9, and 91.6±7.1, respectively. Average postoperative VAS scores and AOFAS Ankle-Hindfoot scores were significantly improved compared with those before surgery. There was no statistically significant difference among all check point after operation in VAS scores and AOFAS Ankle-Hindfoot scores. At the latest follow-up, all patients were satisfied with the degree of painful relief. According to AOFAS Ankle-Hindfoot scores, overall excellent and good rate was 93.3% (excellent in 10 cases, good in 4 cases, and fair in 1 case). Conclusion Clinical results of arthroscopic debridement combined with microfracture for treatment of chronic enthesiopathy of Achilles tendon are good. This technique is easy and safe to perform. Key words: Arthroscopy; Arthroplasty, subchondral; Achilles tendon; Heel pain

Outcomes of arthroscopic debridement and arthrolysis for non-trauma elbow stiffness

Outcomes of arthroscopic debridement and arthrolysis for non-trauma elbow stiffness

Outcomes of arthroscopic debridement and microfracture for osteochondral lesions of the talus

Outcomes of arthroscopic debridement and microfracture for osteochondral lesions of the talus

Arthroscopic management of thumb base arthritis

Thumb base arthritis is a common condition. Arthroscopic or arthroscopic assisted procedures offer better visualisation, less invasiveness, faster recovery, and help to guide the treatment decision. From Apr 2002 to Aug 2013, 76 thumb base arthroscopic debridement & synovectomy was performed in 65 patients (female 51, male 14) at the average age of 56. All patients failed nonoperative care for 6 months. They were follow-up on average of 59 months. Thirty-eight cases were Eaton & Littler stage II, 36 stage III, I stage IV and I stage I. The operation was done under local or regional anaesthesia. Synovectomy, debridement of frayed capsule and radio-frequency ablation were done in all, loose bodies were removed in 25, and thermal shrinkage was done in 30 cases. Post-thermal shrinkage immobilisation was given for 3–6 weeks. Twelve cases had smoothening of the bony surface & prominent osteophytes. Sixty-nine cases experienced pain relief after the operation. Twenty scored excellent while 14 good results. Mean grip strength of 88.3% of the contralateral side while pinch power of 81.7%. Kapandji index was 8. DASH score was 26.5. Patient satisfaction was 77/100. There was no complication encountered. Seven patients requested the same operation on the other thumb after the operation. Three requested repeating the same operation on the same thumb as pain relief lasted only for 1–3 years. Better outcomes were found to be statistically related to bone surface smoothening, or thermal shrinkage and immobilisation for ≥ 4 weeks. Arthroscopic surgery on thumb base arthritis is a safe, easy and feasible buy time surgery. Long-term results of arthroscopic debridement and synovectomy, the surgical techniques, and the examples of arthroscopic assisted procedures at the thumb base were also demonstrated and discussed.

Relationship between probability of future shoulder arthroplasty and outcomes of arthroscopic debridement in patients with advanced osteoarthritis of glenohumeral joint.

BackgroundArthroscopic glenohumeral debridement for symptom control has shown promising short term results in the young active population, when arthroplasty may not be a practical option due to the recommended activity restrictions, potential for complications and/or early wear, and a need for revision. The purpose of this study was twofold: 1) to examine the impact of arthroscopic debridement with or without subacromial decompression on clinical outcomes in patients with severe glenohumeral osteoarthritis (OA), and 2) to explore the differences in post-debridement outcomes between patients who eventually progressed to arthroplasty vs. those who did not. The role of an active worker’s compensation claim was examined.MethodsProspectively collected data of patients who were not good candidates for shoulder arthroplasty and had subsequently undergone arthroscopic shoulder debridement were used for analysis. Disability was measured using the relative Constant-Murley score (CMS), the American Shoulder and Elbow Surgeon’s (ASES) assessment form, pain free range of motion (ROM), and strength.ResultsFifty-six patients were included in the final analysis. Eighteen (32 %) patients underwent arthroplasty surgery (arthroplasty group) over a period of 11 years. The arthroplasty group was comparable with the non-arthroplasty group prior to debridement but was more disabled at post-debridement surgery follow-up, functioning at less than 50 % of normal based on ASES, relative CMS, and active painfree ROM. In the multivariable analysis, the post-debridement relative CMS was affected by having a compensation claim and having a future arthroplasty.ConclusionArthroscopic debridement improved clinical outcome in 68 % of patients suffering from advanced OA of glenohumeral joint. Having less than 50 % of normal score in ASES, relative CMS and painfree ROM post- debridement within a period of two years may be an indication for future arthroplasty. Role of worker’s compensation claims should not be underestimated.

Long-Term Efficacy of Arthroscopic Debridement on Knee Osteoarthritis in Patients with Kashin-Beck Disease.

Kashin-Beck Disease (KBD) is a chronic and degenerative joint disease with decreased health conditions causing major functional limitations and disability. In this study, we investigated the long-term clinical outcomes of arthroscopic debridement for knee osteoarthritis in KBD patients with Kellgren-Lawrence I-III classification. 31 KBD patients underwent arthroscopic debridement and 24 of them were followed up 8years after the surgery. The Lysholm scores, femorotibial angle (FTA), and joint space angle (JSA) of the knees were assessed and compared preoperatively and postoperatively to evaluate the clinic outcome. Our results showed that the Lysholm scores, but not the FTA or JSA, of these patients were significantly improved 8years after the therapy, suggesting that arthroscopic surgery has long-term efficacy in KBD patients with Kellgren-Lawrence I-III classification.

Clinical Outcome of Arthroscopic Debridement for Septic Arthritis of Shoulder

Clinical Outcome of Arthroscopic Debridement for Septic Arthritis of Shoulder

Treatment of OA of the Knee in the Middle-aged Athlete

Knee arthroscopy for patients with osteoarthritis remains controversial. The outcome of arthroscopic debridement in a patient with symptomatic arthritis, and in the absence of mechanical symptoms, is inconsistent and short lived. However, in carefully selected patients with mild or moderate arthritis on standing radiographs, with the acute onset of symptoms, well-localized joint line pain, and painful mechanical symptoms, improved knee function can be expected. Regardless, the natural history of the disease process is unaltered. Patients, especially higher demand middle-aged athletes, must be counseled about the prognosis of degenerative arthritis, the limited positive effects of the arthroscopic procedure, the potential for complications, and the probable need for reconstructive surgery in the future.

Outcomes of Arthroscopic Debridement of Septic Elbows

Outcomes of Arthroscopic Debridement of Septic Elbows

Outcome of Arthroscopic Debridement and Microfracture as the Primary Treatment for Osteochondral Lesions of the Talar Dome

The purpose of this systematic review was to determine patient outcomes after arthroscopic debridement and microfracture for osteochondral lesions (OCLs) of the talar dome. Infotrieve-PubMed/MEDLINE and Google Scholar were systematically searched for the following terms: microfracture AND ankle OR talus. In addition, we hand-searched common American and European orthopaedic and podiatric surgical journals for relevant manuscripts. Articles considered for inclusion were published in peer-reviewed journals, used the American Orthopaedic Foot & Ankle Society hindfoot scoring system for outcome measurement, and involved arthroscopic debridement and microfracture for OCL of the talar dome. We identified 29 potentially relevant publications, of which 7 met our inclusion criteria. A total of 295 patients (299 ankles) were included in this study. The weighted mean postoperative American Orthopaedic Foot & Ankle Society hindfoot score was 86.8 points, translating to good to excellent outcomes in 80.2% of patients. Many techniques exist for the treatment of OCLs of the talar dome. Good to excellent results can be consistently reached in greater than 80% of patients with arthroscopic debridement and microfracture. However, additional prospective trials should be undertaken to determine differences in outcome between techniques, size and location of the OCL, and other patient quality factors, such as cost and time to return to work. Level IV, systematic review of Level II, III, and IV studies.

Paper 225: Factors Affecting Postoperative Outcome of Arthroscopic Debridement for Hip Osteoarthritis

Paper 225: Factors Affecting Postoperative Outcome of Arthroscopic Debridement for Hip Osteoarthritis

Arthroscopic debridement with continuous irrigation for septic arthritis of the shoulder joint

Purpose The purpose of this study was to investigate the outcome of arthroscopic debridement with continuous irrigation in patients with septic arthritis of the shoulder joint.

Arthroscopic treatment of osteochondritis dissecans of the capitellum

The results of arthroscopic debridement and loose body retrieval for osteochondritis dissecans (OCD) of the capitellum in 29 symptomatic patients who had failed conservative management are described. There were no complications of surgery. At an average of 77 months after operation the majority of patients had mild or no pain but with some discomfort during heavy lifting and sport. All were capable of performing simple activities of daily living, and all but one had good or excellent outcomes and rated their satisfaction highly. Only 4 of 27 patients had to give up their preferred sport because of persistent elbow problems. Thirty-eight percent of patients had recurrence of locking or catching, although these symptoms were described as better than the condition before operation and none wanted further surgical intervention. It is concluded that arthroscopic debridement and removal of loose bodies is a safe and reliable procedure for patients with persistent symptoms from OCD of the capitellum.

透析膝に対する鏡視下手術の治療経験

透析膝に対する鏡視下手術の治療経験

Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement

In order to determine indications for arthroscopic debridement and the management of triangular fibrocartilage complex (TFCC) tears, we reviewed 16 wrists retrospectively. The mean patient age was 30 years, with a range of 20 to 53 years. The follow-up period averaged 35 months. Two groups were identified: post-traumatic tears (n = 11) and degenerative tears (n = 5). The results of arthroscopic debridement were compared and analyzed based on the preoperative and postoperative evaluation of pain, range of motion, grip strength, return to work, patient acceptance, and complications. Failures were further evaluated to determine identifiable lesions or anatomic defects associated with poor results. Patients with positive ulnar variance and lunotriquentral interosseous ligament tears had a poor clinical outcome. Good results correlated with grip strength; all patients with post-traumatic TFCC tears had excellent results, while those with degenerative TFCC tears did poorly.

Short-term results of arthroscopic debridement for dialysis arthropathy of the shoulder

Short-term results of arthroscopic debridement for dialysis arthropathy of the shoulder