Role Of Arthroscopy Research Articles

Hip Impingement: The Role of Arthroscopy

Arthroscopic treatment of hip impingement secondary to an abnormal head-neck offset reliably improves symptoms, restores hip morphology, and ultimately may halt the progression toward degenerative joint disease in certain patients.

Surgical Approaches in Osteoarthritis: Role of Arthroscopy

uman osteoarthritis (OA) is a heterogeneous andmultifactorialdiseasewithmultiplepathogeneticmech-anism implicated in its development and progression. Carti-lage degradation and loss are the major features of OA; de-generative changes include fibrillation, chondrocyteproliferation into cell clusters, and matrix disruption. Al-though biomechanical factors are strongly implicated, it isunclear which stimuli regulate the hyperactive phenotype ofOAchondrocytes,includingtheirabilitytoexpresscartilage-degradingproteinases(1).Recentstudieshaveimplicatedtheupregulation of several matrix-degrading metalloproteinases(MMPs)inOAcartilageandhavesuggestedthatchondrocyteproduction of MMPs in OA cartilage reflects local synthesisthat varies with the extent of cartilage degeneration. Thedemonstration of chondrocytes producing interleukin-1and tumor necrosis factor Theseverityofcartilagelesionshasbeenassessedusinganwithin the superficial zones ofOA cartilage supports the concept that cytokine-MMP asso-ciations contribute to a highly catabolic state, chondrocyteapoptosis, and the resultant progressive degeneration of ar-ticular cartilage (2-6).

Metal and plastic suture anchors for rotator cuff repair

The role of arthroscopy in the treatment of rotator cuff tears continues to evolve and expand. The arthroscope offers several advantages to open techniques. It provides clear visualization of the glenohumeral joint, smaller incisions, no deltoid detachment, less soft-tissue dissection, less pain, and more rapid rehabilitation. The past few decades have seen explosive technological advances in the availability of arthroscopic implants, as well as improvement in equipment designs that have made arthroscopy an effective and efficient treatment tool. The development of suitable arthroscopic implants has been critical to the success of arthroscopic tissue repair. These various suture anchors are often used to reattach torn tissue back to bone in the shoulder. The past decade has seen a proliferation in the designs and types of suture anchors available, and this proliferation in implant availability often presents a confusing plethora of options. Each anchor has individual characteristics that influence the appropriateness of its usage including size, shape, composition, and holding strength. In light of the prodigious and voluminous anchor options, we attempt to concisely discuss the individual characteristics and provide quantitative data for the various metal and plastic suture anchors. We divide the anchors into 5 groups based on composition and morphology consisting of metal screw anchors, nonscrew metal anchors, minianchors, plastic suture anchors, and newer anchor designs that have not yet been tested in comparative biomechanical studies.

The Role of Arthroscopy in the Treatment of Glenohumeral Arthritis

Glenohumeral arthritis has traditionally been a disease with a limited arsenal of treatment. Once medical management is no longer effective for pain relief, patients usually are offered a shoulder arthroplasty as the main surgical treatment. This operation is reliable for pain relief, but not as efficient in reestablishing motion to the patient. Moreover, patients with glenohumeral arthritis are often older, and have associated co-morbidities with multiple medical conditions that may be contraindications to a major surgery. A less invasive arthroscopic debridement of patients with severe grade IV glenohumeral arthritis has shown reliable improvements in both pain and function. Isolated arthroscopic debridement is a relatively low risk procedure that relieves pain in nearly 80% of patients with severe glenohumeral arthritis by 3 months, and may provide relief for more than 4 years. It can be considered as a temporizing procedure that may be included in the algorithm of management of patients with severe shoulder arthritis.

The role of arthroscopy in the management of lunotriquetral arthritis

The role of arthroscopy in the management of lunotriquetral arthritis

The role of arthroscopy in chronic anterior shoulder dislocation: technique and early results

Dislocation that lasts longer than 3 weeks is called chronic or unreduced shoulder dislocation. Treatment alternatives can be closed reduction, open reduction, resection arthroplasty, prosthesis, arthrodesis, and no therapy. The English-language literature includes no evidence on arthroscopic reduction for the treatment of unreduced shoulder dislocation. The goal of our study was to present our technique and period results on the arthroscopic reduction we performed in 2 cases 4 and 5 weeks after anterior shoulder dislocation. Reduction could not be achieved by closed reduction under anesthesia. With arthroscopic visualization, adhesions within the joint were released with blunt dissection. Repeat reduction attempts were unsuccessful in these 2 cases. Labroligamentous lesions of the inferior glenohumeral ligament were repaired using 3 absorbable tacks. On the second day after the surgery, isometric exercises were started. The results were evaluated using a 100-unit test recommended by Rowe and Zarins (80 units in case 1; 85 units in case 2). Reduction of chronic unreduced shoulder dislocations using arthroscopy is an alternative technique for selected patients. It also allows repair and treatment of the intra-articular pathology in the joint and makes early postoperative rehabilitation possible.

Advances in surgical management of superior labrum, anterior-to-posterior lesions

Superior labrum, anterior-to-posterior lesions of the shoulder have become a well-recognized entity over the past several years. The expanded role of arthroscopy in the diagnosis and management of shoulder disorders in general has improved our understanding of pathologic conditions involving the glenoid labrum. From an anatomic perspective, superior labrum, anterior-to-posterior tears involve a disruption of the superior labrum and biceps anchor. This injury commonly results in shoulder pain, often with associated clicking or popping, and a resultant loss of shoulder function. Disruption of the biceps anchor may also contribute to subtle instability of the glenohumeral joint. The prevalence of superior labrum, anterior-to-posterior tears, especially in throwing athletes, has been documented. However, issues that continue to evolve include the precise mechanism of injury, the biomechanical role of the biceps anchor, the most effective means of diagnosis, and the optimal surgical management. This article reviews current understanding of superior labrum, anterior-to-posterior lesions with an emphasis on diagnostic methods and recent advances in surgical repair. The most relevant literature on this topic is highlighted.

Thumb trapeziometacarpal joint arthritis: is there a role for arthroscopy?

Thumb trapeziometacarpal joint arthritis: is there a role for arthroscopy?

Arthroscopic and open management of dynamic scaphoid instability

This article focuses on the pathophysiology and treatment of dynamic scaphoid instability. Cadaver studies suggest that dynamic instability results from isolated injury to the scapholunate interosseous ligament without damage to the dorsal intercarpal and dorsal radial lunotriquetral ligaments. The diagnosis may be made by dynamic fluoroscopic examination, including stress and load views. The role of arthroscopy is twofold: (1) it enables the surgeon to distinguish between a complete, grossly unstable scapholunate interosseous space that requires open treatment and (2) it permits direct visualization of the reduction and percutaneous pinning of the articulation in an effort to stabilize the joint. Operative indications, open and arthroscopic techniques, and results are discussed.

What practical skills do rheumatologists of the future need?

In this chapter, we consider future practical skills required for rheumatologists. While difficult to predict against a background of rapid technological advance and successive changes to health-care provision world wide, a number of questions are examined. The first question is what core skills are essential in the curriculum? This has been addressed in at least one joint European effort by UEMS. Great diversity in both clinical practice and training was found across Europe; clearly, the difference across continents may prove even more significant. Second, the role of arthroscopy is considered, the evidence for its therapeutic benefit in clinical rheumatology practice being inconclusive. Issues concerning diagnostic methods including electrophysiology and ultrasound (US) are also discussed in this chapter. There is evidence to support the use of electrophysiology in routine diagnosis for specific diseases. US has become popular as technology improves. It is cheap but highly operator dependent, and the feasibility of rheumatologists using US in the clinic remains to be proved. In conclusion, health care is changing rapidly, and training must adapt, and is adapting, to meet its challenges. A number of opportunities will present to the rheumatologist of the future, but the feasibility of these in routine clinical practice remains to be seen.

Osteonecrosis of the knee after arthroscopic surgery for meniscal tears and chondral lesions

Purpose: Avascular necrosis of the knee following arthroscopic surgery has been described. The purpose of this article is to report a large series of patients who developed avascular necrosis after arthroscopy of the knee in an effort to delineate casual factors and results of treatment. Type of Study: Case series. Methods and Materials: The charts, radiographs, and magnetic resonance imaging (MRI) scans of patients who developed osteonecrosis (ON) of the knee after routine arthroscopic surgery were reviewed. Only those patients with no evidence of ON on preoperative MRI performed 6 weeks or longer after symptom onset and who postoperatively developed ON confirmed by repeat MRI and/or by pathological testing (specimens obtained at subsequent total knee arthroplasty) were included in the study. Seven patients with average age of 60 years (range, 41 to 79 years) met these inclusion criteria. Results: The lesions noted at arthroscopy included 4 medial meniscus tears, 3 lateral meniscal tears, 6 chondromalacia of the medial femoral condyle, 2 chondromalacia of the medial tibial plateau, 1 chondromalacia of the lateral femoral condyle, 1 chondromalacia of the lateral tibial plateau, and 2 chondromalacia of the patella. The location of postarthroscopy ON correlated geographically with pre-existing pathology. All 7 patients had meniscal and/or chondral lesions addressed surgically in the compartment that subsequently developed ON. Six of the 7 patients had an adjacent ipsilateral meniscus tear treated with partial meniscectomy (4 medial, 2 lateral). In addition, of the 4 patients who developed ON of the medial femoral condyle, all had overlying chondromalacia, 3 of whom were treated with arthroscopic chondroplasty. Of the 2 patients with lateral meniscal tears, 1 developed ON of the lateral femoral condyle and the other developed ON of the lateral tibial plateau. Three patients went on to require total knee arthroplasty, and 2 high tibial osteotomy. One patient's ON resolved and another patient was lost to follow-up. Conclusion: ON should be considered in patients who have worsening symptoms after arthroscopy of the knee. These findings suggest a possible relationship between arthroscopic treatment of chondral and meniscal lesions and later appearance of ON in some patients. The role of arthroscopy in the development of ON needs to be further studied. Those at risk are elderly patients with chondral and meniscus lesions.

THE ROLE OF ARTHROSCOPY IN WRIST ARTHRITIS

Recent advances in arthroscopic surgery techniques and instrumentation have enabled the surgeon to improve the treatment of wrist pathology. The arthroscopist can now perform a proximal row carpectomy or radial styloidectomy with minimal dissection and potentially less morbidity. The surgery requires a high level of skill from the surgeon. This is an area of medicine that is still evolving. Long-term studies are lacking but short-term results are promising. In the near future, the role of arthroscopy will better be defined as more research becomes available.

The role of arthroscopy in ankle and subtalar degenerative joint disease.

Treatment options for degenerative joint disease of the ankle and subtalar joints are limited. When conservative management fails, the only effective procedure is arthrodesis. With the advent of the small arthroscope and the development of better instrumentation and distraction techniques, small joint arthroscopy has gained popularity as an important diagnostic and therapeutic tool in the treatment of ankle and subtalar disorders. Although the benefits of arthroscopic ankle arthrodesis are well established, and arthroscopic subtalar arthrodesis has been described recently, the role of arthroscopic debridement for degenerative joint disease of the ankle and subtalar joints remains controversial. Traditionally, operative arthroscopy for ankle arthritis has not met with great success; however, recent studies have shown that it can provide an interim alternative to arthrodesis in early arthritis with preserved range of motion. Lesions associated with arthritis, such as impinging osteophytes and loose bodies, can be treated effectively with arthroscopy.

Traumatic Anterior Glenohumeral Instability: The Role of Arthroscopy.

The static and dynamic stabilizers of the glenohumeral joint act together to ensure joint stability throughout the wide range of normal shoulder motion. These structures are functionally altered after a traumatic anterior shoulder dislocation, often resulting in recurrent instability. The arthroscope has enhanced the surgeon's ability to examine and repair the unstable glenohumeral joint. The rate of recurrence of instability after arthroscopic stabilization has historically been unacceptably high compared with that after open stabilization techniques. The authors offer a treatment algorithm and suggest guidelines for the use of arthroscopic techniques in the treatment of the unstable shoulder.

The role of arthroscopy in the management of temporomandibular disorders

The role of arthroscopy in temporomandibular disorders (TMDs) has given us an opportunity to glean new knowledge and thus develop new technology and treatments. Arthroscopy of the temporomandibular joint (TMJ) suggests that, contrary to existing thought, TMDs are not predominantly caused by an anteriorly displaced disk. Instead we find a variety of pathologic conditions: adhesions, degenerative changes, loose bodies, bruxism dents, cartilage flaps, perforations, anterior tears, and posterior tears. A posterior tear or anterior displaced disk occurs 12% of the time. To treat every patient with TMD with an anterior repositioning splint by manipulation would appear to be using the wrong method of treatment for 88% of the pathologies found. There are two types of cartilage in human joints: hyaline, which is load-bearing, and fibrocartilage, which is the cartilage lining the condylar fossa, the articular eminence, and the TMJ disk. Fibrocartilage is histologically and chemically lacking the percentage of proteoglycans (present in hyaline cartilage) to withstand compressive loading. Therefore, loading fibrocartilage causes degeneration. When fibrocartilage receives compressive loading, matrix degeneration occurs, which leads to fibrillation and cartilage death. Because the human body heals by fibrin/clot formation and cartilage has no blood supply, cartilage will not heal. Cartilage will only wear or degenerate. Cartilage wearing is not remodeling. Loaded excessively, degeneration will occur. A series of corrected tomographs and computed tomographic scans clearly demonstrate the deleterious effects of loading (see Alpern et al.1).

Osteoarthritis in Elderly Knees

This review of osteoarthritis of the knees in the elderly touches on the clinical presentation and examination, epidemiology, etiology, radiologic characteristics, and origin of the pain. The discussion includes drug treatment, intra-articular drug use, nondrug therapy, and the role of arthroscopy and joint lavage.

Jaw Joint Dysfunction and Endotracheal Intubation

To the Editor: We are concerned that the report entitled "Iatrogenic Disruptions of Right Temporomandibular Joints During Orotracheal Intubation Causing Permanent Closed Lock of the Jaw" [1] may be misinterpreted, particularly by the legal profession. Jaw joint dysfunction after anesthesia, laryngoscopy, and endotracheal intubation does not automatically imply faulty technique and may occur when appropriate care and skill have been exercised. It is important that the role of arthroscopy be properly appreciated. The condition of "closed lock" is not necessarily permanent as implied in the paper. Early arthroscopy with manipulation and lavage may correct the situation. In both the cases cited, there was a delay of several months between diagnosis and confirmatory imaging studies, and no mention was made of any arthroscopic intervention. Failure of the disk to retract normally on jaw closure may be due to causes other than "rupture of the superior retrodiscal ligament." The disk may adhere to the eminence in a "sticky joint," the so-called "suction cup effect," and this may be remedied by arthroscopy with lavage and manipulation. Furthermore, some patients have inherently lax ligaments and this leaves the joint prone to subluxation or dislocation without the use of excessive force. We are concerned that some readers unfamiliar with the complexities of the temporomandibular joint and its disorders might conclude that joint dysfunction after laryngoscopy or intubation necessarily implies defective technique. Such is emphatically not the case. We failed to obtain a response from Dr. Gould. Philip Worthington, MD, BSc, FDSRCS Department of Oral and Maxillofacial Surgery University of Washington School of Dentistry Seattle, WA 98195-7134 Frederick W. Cheney, MD Department of Anesthesiology University of Washington School of Medicine Seattle, WA 98195-6540

Jaw Joint Dysfunction and Endotracheal Intubation

To the Editor: We are concerned that the report entitled "Iatrogenic Disruptions of Right Temporomandibular Joints During Orotracheal Intubation Causing Permanent Closed Lock of the Jaw" [1] may be misinterpreted, particularly by the legal profession. Jaw joint dysfunction after anesthesia, laryngoscopy, and endotracheal intubation does not automatically imply faulty technique and may occur when appropriate care and skill have been exercised. It is important that the role of arthroscopy be properly appreciated. The condition of "closed lock" is not necessarily permanent as implied in the paper. Early arthroscopy with manipulation and lavage may correct the situation. In both the cases cited, there was a delay of several months between diagnosis and confirmatory imaging studies, and no mention was made of any arthroscopic intervention. Failure of the disk to retract normally on jaw closure may be due to causes other than "rupture of the superior retrodiscal ligament." The disk may adhere to the eminence in a "sticky joint," the so-called "suction cup effect," and this may be remedied by arthroscopy with lavage and manipulation. Furthermore, some patients have inherently lax ligaments and this leaves the joint prone to subluxation or dislocation without the use of excessive force. We are concerned that some readers unfamiliar with the complexities of the temporomandibular joint and its disorders might conclude that joint dysfunction after laryngoscopy or intubation necessarily implies defective technique. Such is emphatically not the case. We failed to obtain a response from Dr. Gould. Philip Worthington, MD, BSc, FDSRCS Department of Oral and Maxillofacial Surgery University of Washington School of Dentistry Seattle, WA 98195-7134 Frederick W. Cheney, MD Department of Anesthesiology University of Washington School of Medicine Seattle, WA 98195-6540

The role of arthroscopy in the investigation of wrist disorders

The findings at arthroscopy of the wrist in 48 consecutive cases carried out over a 4.5 year period have been retrospectively reviewed. In correlating the clinical and arthroscopic findings in the 36 patients with wrist instability and triangular fibrocartilage injuries we found concurrence in 28 of the cases. In the six patients in whom we were unable to make any provisional clinical diagnosis we did not find arthroscopy helpful. Arthroscopy usefully influenced the management in two of the six patients in whom the articular surface was assessed. We feel that a careful clinical examination of the wrist is the mainstay of diagnosis in wrist disorders. Arthroscopy remains useful in selected cases but has a limited specialized role which should continue to be provided from specialist centres.

Coxa Saltans: The Snapping Hip Revisited.

Coxa saltans, or "snapping hip," has several causes. These can be divided into three types: external, internal, and intra-articular. Snapping of the external type occurs when a thickened area of the posterior iliotibial band or the leading anterior edge of the gluteus maximus snaps forward over the greater trochanter with flexion of the hip. The internal type has a similar mechanism except that it is the musculotendinous iliopsoas that snaps over structures deep to it (usually the femoral head and the anterior capsule of the hip). Intra-articular snapping is due to lesions in the joint itself. Diagnosis of the external and internal types is usually made clinically. Radiography can be useful in confirming the diagnosis, particularly when bursography shows the iliopsoas tendon snapping with hip motion. Other radiologic modalities, such as computed tomography, magnetic resonance imaging, and arthrography, may also be helpful, especially when there is an intra-articular cause. Most cases of snapping hip are asymptomatic and can be treated conservatively. However, if the snapping becomes symptomatic, surgery may be necessary. There may also be a role for arthroscopy in the treatment of intra-articular lesions.