Removal Of Loose Bodies Research Articles

Neuromechanisms of simulation-based arthroscopic skills assessment: a fNIRS study.

The neural mechanisms underlying differences in the performance of simulated arthroscopic skills across various skill levels remain unclear. Our primary objective is to investigate the learning mechanisms of simulated arthroscopic skills using functional near-infrared spectroscopy (fNIRS). We recruited 27 participants, divided into three groups: novices (n = 9), intermediates (n = 9), and experts (n = 9). Participants completed seven arthroscopic tasks on a simulator, including diagnostic navigation, triangulation, grasping stars, diagnostic exploration, meniscectomy, synovial membrane cleaning, and loose body removal. All tasks were videotaped and assessed via the simulator system and the Arthroscopic Surgical Skill Evaluation Tool (ASSET), while cortical activation data were collected using fNIRS. Simulator scores and ASSET scores were analyzed to identify different level of performance of all participants. Brain region activation and functional connectivity (FC) of different types of participants were analyzed from fNIRS data. Both the expert and intermediate groups scored significantly higher than the novice group (p < 0.001). There were significant differences in ASSET scores between experts and intermediates, experts and novices, and intermediates and novices (p = 0.0047, p < 0.0001, p < 0.0001), with the trend being experts > intermediates > novices. The intermediate group exhibited significantly greater activation in the left primary motor cortex (LPMC) and left prefrontal cortex (LPFC) compared to the novice group (p = 0.0152, p = 0.0021). Compared to experts, the intermediate group demonstrated significantly increased FC between the presupplementary motor area (preSMA) and the right prefrontal cortex (RPFC; p < 0.001). Additionally, the intermediate group showed significantly increased FC between the preSMA and LPFC, RPFC and LPFC, and LPMC and LPFC compared to novices (p = 0.0077, p = 0.0285, p = 0.0446). Cortical activation and functional connectivity reveal varying levels of activation intensity in the PFC, PMC, and preSMA among novices, intermediates, and experts. The intermediate group exhibited the highest activation intensity.

Hybrid Fixation for Large Unstable Juvenile Osteochondritis Dissecans Lesions: Midterm Results in Adolescent Patients With Completely or Partially Salvageable Progeny Fragment.

This study aimed to describe the midterm clinical and radiographic outcomes of a hybrid fixation technique (HFT) combining interfragmentary compression with screws and biological support provided by the osteochondral autograft transplantation system (OATS) for treating large unstable juvenile osteochondritis dissecans (JOCD) lesions involving the knee in patients aged ≤18 years. Thirteen patients (15 knees, 9 males) with unstable JOCD lesions in the knee underwent treatment. HFT was indicated for lesions that had a completely salvageable (N=10) or partially salvageable progeny fragment (N=5). Patients were evaluated at a minimum follow-up of 1 year. The mean age of the patients was 15.3 years (range, 11 to 18y), with 10 lesions involving the medial femoral condyle and 5 involving the lateral femoral condyle. The mean lesion area were 397.7mm2. The outcome measures included the Pedi-IKDC and Tegner activity scales. Radiographic evaluation consisted of assessing osteochondral graft integration using the MOCART score on MRI and determining the degree of osteoarthritis using the Kellgren-Lawrence system (KL). At a mean follow-up of 51 months (range, 12 to 143mo), the mean Pedi-IKDC and Tegner activity scale were 90.1±7.2 and 94.7±6.7 points, respectively. Patients with unilateral lesions resumed sports activities on average after 7.7 months (range, 6 to 12mo). All patients exhibited progeny fragment integration on MRI, with a mean MOCART score of 85±6.5 (range, 75 to 95). Radiographs indicated grade 1 KL joint space in 13 knees and grade 2 in 2 knees. At the last follow-up, 12 patients were asymptomatic, whereas 1 patient experienced occasional mild discomfort during intense physical activity. Six patients required additional surgery for hardware removal, and 1 patient underwent intra-articular loose body removal. The hybrid fixation technique showed promising outcomes in terms of fragment healing and midterm results for unstable JOCD lesions. These findings suggest that HFT can be considered a valid treatment option for large unstable lesions involving the femoral condyles of the knee in adolescents. Therapeutic study (level of evidence IV).

Hip Arthroscopy After Total Hip Arthroplasty Is Rare (0.04%) and May be Contralateral

PurposeThe purpose of this study was to determine the patient demographics and incidence of hip arthroscopy after total hip arthroplasty using the PearlDiver database. MethodsThis is a retrospective study of patients undergoing total hip arthroplasty and arthroscopic hip surgery. The PearlDiver Claims Database was queried using CPT codes for records from 2010-2021. Inclusion criteria were presence of a hip arthroplasty CPT code, followed by a hip arthroscopy CPT code. Additional data collected included age, gender, and time between surgeries. A sub-analysis for ICD9/10 codes was completed to estimate association with iliopsoas tendinitis. ResultsQuery of the database showed that 314 patients had a hip arthroscopy code after a hip arthroplasty code. 0.04% of patientswho underwent arthroplasty subsequently underwent arthroscopy. 63.4% were female. Mean age was 58.2 ± 12.2 years at time of arthroscopy. 214 (72.3%) patients had a CPT code for synovectomy, 56 (18.9%) for loose body removal, and 44 (15.3%) for diagnostic arthroscopy. The mean time from arthroplasty code to arthroscopy code was 2.5 ± 2.0 years. 105 patients (33.4%) also had an ICD 10 diagnosis code for iliopsoas tendinitis and 116 (36.9.0%) had the ICD 9 code for enthesopathy of hip. ConclusionIn this limited study, we found that hip arthroscopy after hip arthroplasty is uncommon but occurs more frequently in female patients, is undertaken in a broad age range of patients, and is often associated with a diagnosis of iliopsoas or hip tendinitis. Level of Evidence: Level IV, Retrospective Case Series

Fresh Osteochondral Allograft Transplantation of the Capitellum for the Treatment of Osteochondritis Dissecans

Background: Osteochondritis dissecans (OCD) of the humeral capitellum is a rare and challenging condition to treat. Several surgical options exist, but in the last few years, the pendulum has swung from debridement and microfracture to restoration of the articular surface. Osteochondral autografts from the rib and knee have been described, but donor-site morbidity is a concern. Purpose: To expand the results of fresh osteochondral allograft transplantation (FOCAT) in a previously published report with inclusion of additional patients and a longer follow-up period. Study Design: Case series; Level of evidence, 4. Methods: After institutional review board approval, the charts of patients who underwent FOCAT for OCD of the capitellum between 2006 and 2022 by a single surgeon were reviewed. The majority of cases (94%) had unstable lesions (Minami grades 2 and 3). A trial of nonoperative treatment had failed in all. All patients underwent diagnostic arthroscopy, followed by a mini-open, ligament-sparing approach with grafting using commercially available guides and instruments. Results: A total of 35 patients were identified, of whom 25 were male. The mean age was 16 ± 3.9 years (range, 11-32 years). There were 24 baseball players (19 pitchers and 5 position players), 5 gymnasts, 3 cheerleaders/tumblers, 1 tennis player, 1 student (who did not participate in athletics), and 1 patient with avascular necrosis from chemotherapy. Eighteen patients had a mean flexion contracture of 14.1°± 11.9°. A single osteochondral allograft plug was used in 23 patients (mean diameter, 11.3 ± 2.8 mm), and 12 patients required 2 plugs (Mastercard technique). The mean follow-up was 92.6 ± 54.5 months (range, 24-204 months). There was significant improvement in Oxford (from 25.5 ± 4.9 to 46.7 ± 3.5; P < .00001) and visual analog scale for pain (from 7.5 ± 2 to 0.3 ± 1.0; P < .0001) scores. The mean Single Assessment Numeric Evaluation score at the time of follow-up was 90.6 ± 10.8 (range, 60-100). In overhead athletes, there was significant improvement in the Kerlan-Jobe Orthopaedic Clinic score (from 40.8 ± 11.8 to 90.6 ± 10.8; P < .00001). A postoperative magnetic resonance imaging scan was obtained in 16 (46%) patients at a mean of 32.6 months. In all cases, the graft was incorporated. All overhead athletes were able to return to their sport and perform at the same level or higher for >2 years. Two elbows required a subsequent arthroscopy for loose-body removal; otherwise, there were no other complications. Conclusion: FOCAT is an excellent option for treating OCD lesions of the humeral capitellum. Excellent outcomes and high return-to-sport rates were observed, with midterm follow-up showing no graft failures. FOCAT eliminates donor-site morbidity.

Paper 49: Osteochondral Allograft Transplantation for Capitellar Osteochondritis Dissecans: Excellent Patient Reported Outcomes Scores and High Return to Sports

Objectives: Unstable osteochondritis dissecans of the capitellum (OCD-C) is treated surgically, most commonly with loose body removal and marrow stimulation. This treatment has historically been associated with suboptimal return to high-demand upper extremity sports (baseball and gymnastics) and persistent elbow pain. Fresh osteochondral allograft transplantation (OAlloT) is an alternative treatment which restores subchondral bone and articular cartilage without donor site morbidity associated with autograft harvest. The purpose of this study was to evaluate the outcomes of osteochondral allograft transplantation in pediatric patients with unstable OCD-C 10mm or greater in size. Methods: A single-center prospective study was performed of consecutive pediatric patients, less than 19 years of age, with unstable OCD-C 10mm or greater in size treated with primary fresh OCAlloT using pre-cut 10mm, 12mm, or 16mm cores. Imaging, including radiographs and MRI were obtained preoperatively to assess OCD size and characteristics, as well as postoperatively to assess incorporation of the OCA. Patient reported outcome scores (PROs), including sport data, were obtained preoperatively and annually following surgery. Minimum follow-up duration was 2 years. Results: 26 elbows in 24 patients, mean age 13.4 years (11.3 – 17.1 years) met inclusion. The most common primary sport was gymnastics in 11 elbows (42%), baseball/softball in 7 elbows (27%), and cheer in 3 elbow (12%). The majority of patients (88%) played at a competitive level. Median symptom duration prior to presentation was 3 months. The most common presenting symptoms were pain (85%) and mechanical symptoms (81%). Sixteen elbows (62%) presented with a &gt;5° loss of elbow extension compared to the contralateral side. The capitellar physis was open in 23 elbows (88%). OCD location was central in 17 elbows (65%) and far lateral in 9 elbow (35%). Mean MRI size of the OCD was 11 mm in coronal width, 12 mm in sagittal length, and 6 mm in depth. Twelve elbows (48%) had a loose body on MRI. The majority of elbows (22, 85%) were treated with a single allograft plug, while 4 elbows had two allograft plugs transplanted. Median OCA size was 12 mm. There were no infections nor arthrofibrosis. Two elbows (8%) had a secondary surgery, both underwent partial synovectomy and chondroplasty at 14- and 16-months following the primary surgery. Postoperative MRIs were obtained in 15 elbows (58%) and had a mean BOGIE (Boston Osteochondral Graft Incorporation in the Elbow) score of 11, thus documenting a high degree of incorporation. Mean follow-up duration was 40 months (range 25 – 60 months). All patients had preoperative, 1-year, and 2-year PROs (Table 1). 21 elbows (81%) had returned to sports at 1-year postoperatively9, and all but 1 patient had returned to sports by 2 years following surgery. Forty-five percent of gymnasts returned to gymnastics, while the remaining pursued different sports. Five of 6 baseball players (83%) returned to baseball. Conclusions: OCAlloT as a treatment for OCD-C is a procedure associated with low rates of complications, excellent graft incorporation, high elbow function and patient satisfaction, and overall high rates of return to sports at 2-years. Return to sports, particularly among gymnasts was less than 50% in this series, which we attribute to a combination of factors, including loss of training and competition time at a critical time for an elite gymnast as well as physician counseling on alternative sports with less stress on the elbow. Continued patient follow-up is ongoing and will be critical to the assessment of this treatment on the mid- and long-term outcomes in these young athletes. [Figure: see text]

Clinical Outcomes and Survivorship of Lateral Unicompartmental Knee Arthroplasty: A Large Single Surgeon Cohort

BackgroundLateral unicompartmental knee arthroplasty (UKA) is an effective treatment for isolated lateral compartment osteoarthritis. However, due to the rarity of the procedure, long-term outcomes and survivorship are poorly understood. We report the clinical and radiographic outcomes after lateral UKA. MethodsWe retrospectively reviewed a consecutive series of patients who underwent lateral UKA by a single fellowship-trained arthroplasty surgeon from 2001 to 2021 with a minimum 2 year follow up. There were 161 knees in 153 patients (average age 69 years) that met inclusion criteria, with a mean follow up of 10.0 years (range 0.05 to 22.2). All patients underwent the procedure via a minimally invasive lateral parapatellar approach with a fixed-bearing implant. Patient demographics, complications, radiographic findings, patient-reported outcomes, and the need for revision surgery were evaluated. Survivorship was defined with the end point as revision of components. ResultsThere were 8 patients (5.0%) who underwent conversion to total knee arthroplasty for lateral UKA implant failure or progression of arthritis. There were 3 patients (1.9%) who underwent ipsilateral medial UKA due to medial compartment arthritis progression with preserved mechanical alignment and patellofemoral joint. There were 8 additional procedures that did not require implant changes, including 5 irrigation and debridements for acute periprosthetic joint infection (3.1%), 2 wound closures for dehiscence (1.3%), and one loose body removal (0.6%). ConclusionsLateral UKA showed a survivorship rate of 98.0% at 5 years, 96.0% at 10 years, and 94.5% at 15 years. When including patients who underwent additional surgery for the progression of arthritis, survivorship was 97.4% at 5 years, 95.4% at 10 years, and 91.3% at 15 years. Lateral UKA should be seen as a durable treatment option for isolated lateral compartment osteoarthritis.

Declining Inflation-Adjusted Medicare Physician Fees: An Unsustainable Trend in Hip Arthroscopy.

Although hip arthroscopy continues to be one of the most used arthroscopic procedures, no focused, comprehensive evaluation of reimbursement trends has been conducted. The purpose of this study was to analyze the temporal Medicare reimbursement trends for hip arthroscopy procedures. From 2011 to 2021, the Medicare Physician Fee Schedule Look-Up Tool was queried for Current Procedural Terminology (CPT) codes related to hip arthroscopy (29860 to 29863, 29914 to 29916). All monetary data were adjusted to 2021 US dollars. The compound annual growth rate and total percentage change were calculated. Mann-Kendall trend tests were used to evaluate the reimbursement trends. Based on the unadjusted values, a significant increase in physician fee was observed from 2011 to 2021 for CPT codes 29861 (removal of loose or foreign bodies; % change: 3.49, P = 0.03) and 29862 (chondroplasty, abrasion arthroplasty, labral resection; % change: 3.19, P = 0.03). The remaining CPT codes experienced no notable changes in reimbursement based on the unadjusted values. After adjusting for inflation, all seven of the hip arthroscopy CPT codes were observed to experience a notable decline in Medicare reimbursement. Hip arthroscopy with acetabuloplasty (CPT: 29915) and labral repair (CPT: 29916) exhibited the greatest reduction in reimbursement with a decrease in physician fee of 24.69% ( P < 0.001) and 24.64% ( P < 0.001), respectively, over the study period. Medicare reimbursement for all seven of the commonly used hip arthroscopy services did not keep up with inflation, demonstrating marked reductions from 2011 to 2021. Specifically, the inflation-adjusted reimbursements decreased between 19.23% and 24.69% between 2011 and 2021.

Mosaicplasty/Osteochondral Autograft Transfer Remains a Durable Solution for Symptomatic Chondral Defects of the Knee: Two to Ten-Year Follow-up Analysis

Objectives: Little to no long-term data exist following mosaicplasty/osteochondral autograft transfer (OATS). The purpose was to assess the long-term outcomes of osteochondral autograft transfer in terms of patient-reported outcomes, reoperation rates, and conversion to arthroplasty. Methods: Between September 1999 through April 2021, 63 patients who underwent mosaicplasty were queried from an institutional cartilage registry with patient reported outcome measures (PROMs), including the 36-Item Short Form Survey (SF-36), the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS), and the International Knee Documentation Committee Subjective Knee Form (IKDC) for OATS surgical procedures from the practice of six fellowship-trained knee specialists. Inclusion criteria were patients treated with mosaicplasty with preoperative PROMs and minimum two-year follow-up. Exclusion criteria were prior ipsilateral surgical procedures, advanced osteoarthritis, revision cartilage procedures, inflammatory arthropathy, or loss to follow-up. The preoperative and minimum two-year clinical outcomes with respect to the SF-36 score, reoperation rates, and conversion to arthroplasty were analyzed Results: Mean age was 27.4 ± 12.4 years and 20/63 (31.7%) were female with a mean follow-up of 5.7 ± 3.2 years. The mean lesion size was 2.3 ± 1.6 cm2 requiring a mean of 2.2 ± 1.3 autograft plugs. Mean IKDC and KOS-ADL increased from 46.4 ± 15.1 and 64.4 ± 16.3 preoperatively to 70.4 ± 22.6 and 83.8 ± 11.7, respectively, at 10-year follow-up. A total of 69% and 67% surpassed the MCID and SCB1,2, respectively, for IKDC at 2-year follow-up; similarly, 60% and 33.3% surpassed MCID and SCB, respectively, for IKDC at 10-year follow-up. The overall reoperation rate was 28.6% at a mean of 43.8 years with partial meniscectomy, chondroplasty, and loose body removal most commonly performed. Two patients required arthroplasty conversion. Conclusions: OATS remains a durable knee preserving cartilage repair operation with low incidence of reoperation 10 years following index procedure.

Short-Term Outcomes of Arthroscopic Treatment of Freiberg Disease.

Surgical treatment for Freiberg disease (also known as avascular necrosis of the metatarsal head) has not been completely defined. This retrospective study evaluated short-term outcomes after arthroscopic treatment of Freiberg disease. From 2015 to 2019, 13 patients (15 feet) diagnosed as having Freiberg disease were enrolled for arthroscopic surgery. Feet were divided based on the Smillie classification system (two with stage I, eight with stage II, three with stage III, one with stage IV, and one with stage V). Arthroscopic interventions, including synovectomy, debridement, chondroplasty, microfracture, and loose body removal, were performed without considering the Smillie classification stage. Radiologic outcomes were evaluated by radiography (preoperatively and 3, 6, and 12 months postoperatively) and magnetic resonance imaging (preoperatively and 12 months postoperatively). Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal (MTP)-interphalangeal score and the visual analog scale (VAS) score. The MTP joint range of motion was measured using a goniometer preoperatively and postoperatively. Radiologic studies showed no evidence of osteonecrosis progression in postoperative 12-month radiographs of any patients. Postoperative 12-month magnetic resonance images showed reduction of bone marrow edema, irregularity of subchondral bone, and cartilage defects in all patients. Significant improvements in AOFAS and VAS scores occurred at all postoperative time points compared with preoperative scores (P = .001). The MTP joint range of motion also showed improvement at last follow-up (P = .001). Arthroscopic surgery for Freiberg disease showed excellent clinical outcomes, MTP joint range of motion, and short-term outcomes regardless of stage (Smillie classification) in radiologic evaluation.

Synovial Chondromatosis of Shoulder Treated by Arthroscopic Synovectomy and Removal of Loose Bodies: A Case Report

Synovial Chondromatosis of the shoulder is mentioned in literature as a rare case. It is a benign neoplastic condition of the synovial membrane. Multiple osteocartilaginous loose bodies inside the joint characterize this rare monoarticular disorder. This case report describes a 32-year-old man who presented with right shoulder pain for six months. He had painful abduction and internal rotation. The condition was diagnosed as synovial chondromatosis. The patient underwent arthroscopic removal of loose bodies and synovectomy. This case illustrates the investigation and treatment of synovial chondromatosis of the shoulder. The loose bodies in synovial chondromatosis of a shoulder joint can be retrieved by arthroscopy as it provides a broader field of vision, better accessible access to the loose bodies, synovectomy, reduced hospital stay, and better rehabilitation. Keywords: Arthroscopy, Loose Bodies, Shoulder, Synovial Chondromatosis

KNEE ARTHROSCOPY: SHOULD KNEE ARTHROSCOPY SIMULATION BE PART OF THE TRAINING CURRICULUM IN THE UK?

IntroductionKnee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited training or experience, furthered by reduced practical education due to COVID-19, this skill can be under-developed amongst trainee surgeons.MethodsAt a single institution, ten junior doctors (FY1 to CT2), were recruited as a part of a five, two-hour session, training programme utilising the Simbionix® ARTHRO Mentor knee arthroscopy simulator, supplemented alongside educational guidance with a consultant orthopaedic knee surgeon. All students had minimal to no levels of prior arthroscopic experience. Exercises completed included maintaining steadiness, image centring and orientation, probe triangulation, arthroscopic knee examination, removal of loose bodies and meniscectomy. Pre and post experience questionnaires and quantitative repeat analysis on simulation exercises were undertaken to identify levels of improvement.ResultsComparing pre and post experience questionnaires significant improvements in levels of confidence were noted in the following domains: naming arthroscopic instruments, port positioning and insertion, recognising normal anatomy arthroscopically, holding and using arthroscopic instruments and assisting in a live theatre setting (p&lt;0.05). Significant improvements were also noted in time taken to complete and distance covered in metres, of the simulated exercises on repeat performance (p&lt;0.05).ConclusionOverall, with only five sessions under senior guidance, using a simulator such as the ARTHRO Mentor, significant improvements in both levels of confidence and skill can be developed even among individuals with no prior experience.

Clinical Outcomes of Adolescents With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions Compared With Isolated Bankart Lesions.

Glenolabral articular disruption (GLAD) lesions may occur in adolescents with anterior shoulder instability, resulting in articular cartilage loss and reduced functional glenoid surface area. To compare failure rates and patient-reported outcomes (PROs) between adolescents with versus without GLAD lesions who were treated for anterior shoulder instability with arthroscopic stabilization. It was hypothesized that the comparison would yield no significant differences. Cohort study; Level of evidence, 3. Patients aged ≤18 years who were treated for anterior shoulder instability with arthroscopic stabilization between 2010 and 2021 were retrospectively identified. Those patients with a GLAD lesion identified at the time of surgery were compared with patients with >2 years of retrospective follow-up who were matched to the no-GLAD cohort according to pathology and management. Demographic and patient characteristics including recurrent instability, complications, and reoperations were recorded. All patients in the GLAD cohort were contacted to obtain PRO data, including the Single Assessment Numeric Evaluation; the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire; and the Pediatric Adolescent Shoulder Survey. Patients were also asked about recurrent instability and additional shoulder problems. Of 35 included patients (mean age, 15.4 ± 1.6 years; 80% male), 15 patients (43%) with GLAD lesions and 26 patients without GLAD lesions were identified. Both cohorts had similar patient characteristics, number of anchors, and anchor constructs; the mean follow-up period was significantly different (GLAD vs no-GLAD, 6.9 ± 3.3 vs 3.4 ± 1.2 years, respectively; P < .001). Seven of 15 GLAD patients (46.7%) underwent loose body removal; 4 of 15 GLAD patients (26.6%) and 9 of 26 no-GLAD patients (34.6%) had recurrent subjective instability (P = .7). No significant group differences were found in PRO scores, reoperation rates (15% no-GLAD vs 20% GLAD), or percentage of patients with recurrent instability between cohorts (P > .05). Adolescent patients with and without GLAD lesions treated arthroscopically for anterior shoulder instability had similar PROs and failure rates at intermediate duration of follow-up. GLAD lesions may be managed in a similar surgical manner as isolated Bankart tears in teenagers, with expectations of similar outcomes.

A spaced retraining schedule with 2-day interval improves the acquisition and retention of simulation-based basic arthroscopic skills.

To compare the effect of three differently spaced retraining schedules (1-day, 2-day, and 1-week intervals) on the acquisition of basic arthroscopic skills and skill retention after 3months. Thirty orthopaedic residents without arthroscopic experience were enrolled in a double-blind, randomised, parallel-controlled trial. Spaced retaining schedules were divided into massed training and retraining phases. Participants were required to obtain perfect scores in all tasks on the simulator in the massed training phase, followed by a pretest to evaluate the training effect. During the retraining phase, participants were randomly assigned to Groups A (1-day interval), B (2-day interval) or C (1-week interval). A posttest was used to evaluate the effect of different retraining patterns. Follow-up evaluations were conducted at 1week, 1month and 3months after the completion of spaced retraining schedules to measure skill retention. One-way ANOVA and paired-sample t tests were used for statistical analysis. Significant between-group differences in diagnostic arthroscopy (137.0 ± 24.8 vs. 140.1 ± 21.3 vs. 175.3 ± 27.4s, P(A-C) = 0.005, P(B-C) = 0.010) and loose body removal (193.1 ± 33.9 vs. 182.0 ± 32.1 vs. 228.7 ± 42.9s, P(B-C) = 0.025) completion times were observed. No significant differences were found in other posttest metrics. An assessment of skill retention after the 3-month follow-up (Evaluation 3) showed significant differences in diagnostic arthroscopy completion time (202.5 ± 53.3 vs. 172.0 ± 27.2 vs. 225.5 ± 42.1s, P(B-C) = 0.026). No significant differences were found in other Evaluation 3 metrics. The 2-day retraining schedule was the most effective for the acquisition and retention of basic arthroscopic skills and could be integrated into arthroscopic skills curricula. After a 3-month follow-up, residents who followed this schedule showed better skill retention than those who followed the 1-week interval schedule. Level I.

Arthroscopic loose body removal following anterior-superior hip dislocation due to low-impact trauma—a case report

Arthroscopic loose body removal following anterior-superior hip dislocation due to low-impact trauma—a case report

Weight-Bearing CT with Maximum Ankle Dorsiflexion to Identify Impingement and Tibial Plafond Stress Fracture: A Case Report.

A 25-year-old male pole vaulter presented with several months of right ankle pain. Radiographs showed an anterior tibial osteophyte with a small intra-articular body suggesting impingement. Weight-bearing computed tomography (CT) revealed an associated tibial plafond stress fracture. Subsequent arthroscopy with osteophyte resection and loose body removal significantly improved symptoms, and he gradually resumed training. Stress fractures should always be considered in athletes with ankle pain. A unique aspect of this case was the use of weight-bearing CT in diagnosis and surgical planning. To our knowledge, this is the first described case in which weight-bearing CT was used in this fashion.

Giant Synovial Chondromatosis of the Shoulder: The Limits of Arthroscopic Treatment and Technical Tips

Synovial chondromatosis (SC) is a rare disease. It is a chondrocytic metaplasia and is characterized by the presence of cartilaginous loose bodies in the involved joint, bursa or tendon sheath, it occurs most often in those aged 30_50 years and 3 times more in males than females, The shoulder is an exceptional location. It causes significant functional disability in young people. The clinical presentation is not specific, and the diagnosis is based on MRI. Confirmation is still anatomopathological. Classically, the mainstay treatment for SC of the shoulder has been open arthrotomy and removal of loose bodies, followed by either complete or partial synovectomy, removing the affected tissue, with recent advances in arthroscopic techniques and methods, arthroscopy becomes the gold standard. We present this case report of a 26-year-old man, who was left-hand dominant, a maintenance technician, amateur football player presented a left shoulder inflammatory pain; ; plain radiography demonstrated multiple calcific densities over the glenohumeral joint , the MRI showed multiple calcified intra-articular loose bodies around the anterior and posterior joint and axillary recess ; At arthroscopy, a large number of loose bodies were observed together with marked synovitis ,it only allowed the removal of small foreign bodies &lt; 1 cm, partial synovectomy was performed with a shaver ; anatomopathological examination confirmed the diagnosis of sc. the extraction of giant fragments &gt;2 cm was impossible so it was subsequently removed by open surgery. This was carried out one month later using a delto-pectoral approach: all foreign bodies &gt; 1 cm were successfully extracted. We report this case report in order to review the role of shoulder arthroscopy and magnetic resonance imaging (MRI) in diagnosis and treatment and to highlight the operative difficulties, technical tips of arthroscopic extraction of giant Synovial chondromatosis of the shoulder.

KNEE ARTHROSCOPY: SHOULD KNEE ARTHROSCOPY SIMULATION BE PART OF THE TRAINING CURRICULUM IN THE UK?

AbstractIntroductionKnee arthroscopy can be used for ligamentous repair, reconstruction and to reduce burden of infection. Understanding and feeling confident with knee arthroscopy is therefore a highly important skillset for the orthopaedic surgeon. However, with limited training or experience, furthered by reduced practical education due to COVID-19, this skill can be under-developed amongst trainee surgeons.MethodsAt a single institution, ten junior doctors (FY1 to CT2), were recruited as a part of a five, two-hour session, training programme utilising the Simbionix® ARTHRO Mentor knee arthroscopy simulator, supplemented alongside educational guidance with a consultant orthopaedic knee surgeon. All students had minimal to no levels of prior arthroscopic experience. Exercises completed included maintaining steadiness, image centering and orientation, probe triangulation, arthroscopic knee examination, removal of loose bodies, and meniscectomy. Pre and post-experience questionnaires and quantitative repeat analysis on simulation exercises were undertaken to identify levels of improvement.ResultsComparing pre and post-experience questionnaires significant improvements in levels of confidence were noted in the following domains: naming arthroscopic instruments, port positioning and insertion, recognising normal anatomy arthroscopically, holding and using arthroscopic instruments and assisting in a live theatre setting (p&lt;0.05). Significant improvements were noted in time taken to complete, distance covered in metres and roughness of instruments used on the simulated exercises on repeat performance (p&lt;0.05).ConclusionWith only five sessions under senior guidance, using a simulator such as the ARTHRO Mentor, significant improvements in both levels of confidence and skill can be developed even among individuals with no prior experience.

Synovial chondromatosis of the temporomandibular joint

When cartilage-like tissue is present in the synovial membrane of joints, it is known as synovial chondromatosis (SC). The main cause is believed to be the metaplasia of embryonal mesenchymal tissue in the synovial membrane. The metaplastic foci grow within the joint space and can detach from the synovial wall, forming free-floating bodies. While SC is more commonly associated with trauma in the temporomandibular joint (TMJ), the exact relationship between trauma and SC remains unclear. Improved diagnostic techniques, such as CT and MRI, have led to increased recognition of SC in the TMJ. Gender differences in the prevalence of TMJ SC have been observed, with women being more affected. Diagnosis involves imaging techniques like X-rays, CT scans, MRIs, and surgical removal of loose bodies is the preferred treatment. Arthroscopy is recommended for small, isolated loose bodies, while open surgery may be necessary for complete removal. Long-term follow-up is essential to monitor for recurrence. Histopathological findings reveal a mixture of cartilage and bone, with ossification and calcification present.

Update in diagnosis, treatment, and prevention of osteochondritis dissecans of the capitellum.

Osteochondritis dissecans of the capitellum is debilitating and is a potentially sports career-ending injury in a young and athletic population. Osteochondritis dissecans typically occurs in patients between the ages of 10 and 24 years, and boys are more commonly affected than girls. Conventional radiographs have low diagnostic accuracy, and magnetic resonance imaging (with or without contrast) or computed tomography may aid in accurate diagnosis. The primary indication for non-operative treatment is the presence of an intact cartilage cap on magnetic resonance imaging, indicating a "stable lesion." However, if operative treatment is necessary, various surgical procedures are available when operative treatment for an osteochondritis dissecans of the capitellum is considered, including open or arthroscopic removal of loose bodies, with or without microfracturing, fragment fixation, osteochondral autograft transplantation, and osteochondral allograft transplantation. The decision-making process for selecting the appropriate treatment considers factors such as the patient's characteristics, functional limitations, and lesion morphology.

Early Postoperative Complications and Associated Variables After High Tibial Osteotomy and Distal Femoral Osteotomy: A 15-Year Experience From a Single Academic Institution

Background: High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are well-recognized treatments to address varus and valgus malalignment, respectively, in the setting of symptomatic unicompartmental arthritis of the tibiofemoral joint. The existing literature is limited in its ability to characterize complications after HTO or DFO procedures. Purpose: The objective of this study was to determine the rate of early (≤90 days) postoperative complications and associated variables from the 15-year experience of a single academic institution. Study Design: Case series; Level of evidence, 4. Methods: Patients treated at a single academic institution between 2008 and 2022 who underwent HTO or DFO procedures were identified. All patients with minimum 90-day follow-up were considered for inclusion in the study. Exclusion criteria were inadequate follow-up, unavailable medical records, age <14 years, and revision osteotomy. Patient demographic characteristics, surgical history, and concomitant procedures were identified, and risk factor analysis was performed to identify variables associated with early postoperative complications. All intraoperative complications were recorded. Results: A total of 243 knees in 232 patients met eligibility and were included in the final analysis. Three intraoperative complications (1.2%) involving fracture extension of the osteotomy occurred. There were 127 early postoperative complications (121 surgical, 6 medical) in 102 knees (68 with HTO and 34 with DFO). Medical complications included pulmonary embolus in 3 patients (1.2%), urinary tract infection in 2 patients (0.8%), and postoperative ileus requiring prolonged hospitalization in 1 patient (0.4%). The most common complications were stiffness requiring a non–standard of care intervention (17.7%), superficial wound infection or wound dehiscence (13.2%), and hemarthrosis or effusion requiring aspiration (6.6%). The rate of deep infection requiring irrigation and debridement was 4.1%. Variables associated with early postoperative complications included smoking (odds ratio [OR], 3.05; 95% CI, 1.34-6.94; P = .008), concomitant chondroplasty and/or loose body removal (OR, 2.55; 95% CI, 1.50-4.33; P = .001), and concomitant ligament reconstruction (OR, 3.97; 95% CI, 1.37-11.53; P = .011). Conclusion: These 15-year data revealed a low rate of intraoperative complications (1.2%) and a relatively high rate of early (≤90 days) postoperative complications (42.0%) after an HTO or DFO procedure. Surgeons should be aware of the increased postoperative complications associated with smoking, concomitant chondroplasty, and concomitant ligament reconstruction and should use this information to counsel patients regarding appropriate expectations in the postoperative period.