Simple Debridement Research Articles

Arthroscopic Chondral Nail Fixation for Treating Acetabular Cartilage Delamination Results in Improved Pain Relief at Minimum 2-year Follow-up in Patients with Femoroacetabular Impingement Syndrome: A Propensity-Matched Study

PurposeTo investigate the clinical outcomes following arthroscopic chondral nail fixation for acetabular cartilage delamination (ACD) in patients with femoroacetabular impingement syndrome (FAIS), and the presentation of ACD on MRI at follow-up. MethodsA retrospective review was performed between March 2021 and March 2022 at our institute. Patients undergoing primary hip arthroscopy for FAIS and diagnosed with ACD intraoperatively were included. Exclusion criteria were incomplete data or loss of minimum 2-year follow-up, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). Patients who underwent chondral nail fixation were matched 1:1 with a control cohort of patients who only underwent simple debridement. Preoperative and minimum 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were collected and compared. MRI was performed preoperatively and at final follow-up to assess ACD. ResultsFifty-eight patients were included in the study (29 patients in each group). Both groups demonstrated improved VAS and mHHS following surgery (all with P < .05). The chondral nail group demonstrated better postoperative VAS (P = .022) compared to the control group, while the postoperative mHHS was comparable between the two groups (P = .852). No significant difference was found in the achievement of MCID between the two groups (all with P > .05). More patients in the chondral nail group achieved PASS of VAS compared to the control group (75.9% vs 48.3%, P = .030). No patient underwent revision surgery or conversion to total hip arthroplasty (THA). The chondral nail group demonstrated significantly higher rate of ACD healing on MRI compared to the control group (P < .001). ConclusionPatients undergoing arthroscopic chondral nail fixation for treating ACD demonstrated significant pain relief, more achievement of PASS of VAS, and higher rate of ACD healing on MRI compared to those undergoing simple debridement. Level of EvidenceLevel III; retrospective cohort study.

CLASSIFICATION OF FREIBERG'S DISEASE: A GUIDE FOR MANAGEMENT

IntroductionThe current treatment for Freiberg's osteochondrosis centres around either: simple debridement or debridement osteotomy. The main principle of the osteotomy is to rotate normal articular cartilage into the affected area. We recommend the use of CT scanning to delineate the amount of available, unaffected cartilage available to rotate into the affected space.MethodsWe retrospectively reviewed 32 CT scans of new Freiberg's diagnoses in Sheffield over a 10 year period using the PACS system. We identified the sagittal CT slice that displayed the widest portion of proximal articular margin of the proximal phalanx and measured the diseased segment of the corresponding metatarsal head as an arc (in degrees). This arc segment was divided by 360°. This gave a ratio of the affected arc in the sagittal plane.Results28 out of 32 cases involved the 2nd metatarsal with the remaining 4 involving the 3rd metatarsal head. Of 32 cases, 18 had fragmentation. Surgically, 20 had debridement only, 5 also had an osteotomy and 1 had a fusion. 6 of the 32 cases were managed non-operatively. 11 cases out of 32 had an arc ratio of &lt; 0.3. Of these, only 3 had an osteotomy, 3 had no procedure and 5 had a simple debridement. Of those that had osteotomies (5/32), 3 of the 5 cases had an arc ratio of &lt; 0.3 with the other 2 being 0.42 and 0.38.DiscussionWe hypothesise that those cases with an arc ratio of less 0.3 would be amenable to a dorsal closing wedge osteotomy and those with a ratio of more than 0.4 would be better suited to a simple debridement. For those cases between 0.3–0.4, we feel either option is viable. Further work to prove or disprove outcomes related to our classification is required.

Current concepts in the aetiology, assessment and management of partial distal biceps tendon tears

Partial distal biceps tendon tears encompass a spectrum of disease. They can be either traumatic or degenerative in nature. Traumatic tears usually involve the short head. Degenerative tears can involve either or both short and long head components with the tear affecting the lateral fibres first. Chronic tears may be associated with a narrow radioulnar space, distinct head insertions and radial tuberosity hypertrophy. Patient history and clinical examination findings suggestive of partial tearing of the distal biceps tendon should be confirmed with advanced imaging. Magnetic resonance imaging allows assessment of the tear size, morphology and associated pathologies. Non-surgical management, including physiotherapy and injections, is appropriate in selected cases. Surgical management can involve either endoscopic or open techniques. In small tears or low demand patients, a simple debridement of the bursa, tuberosity and tendon may be indicated. In larger tears in higher functioning patients, release of the remaining fibres, debridement and an anatomical repair is indicated. In this review paper, the authors present current concepts on the pathogenesis and management of partial distal biceps tendon tears.

Subscapularis Tendon Tears: How Best to Approach This Issue.

Subscapularis tears, either in combination with more extensive rotator cuff pathology or in isolation, are a relatively common cause of shoulder pain and dysfunction which often requires surgical intervention. Similar to the general treatment of most rotator cuff tears, patients may respond to conservative treatment and not require surgical intervention, especially in the elderly or those with partial tears. However, many subscapularis tears require intervention to address complaints of pain, dysfunction, or both. The spectrum of subscapularis tears ranges from low-grade partial requiring simple debridement to full-thickness tears which have become retracted and irreparable necessitating complex repair. Although open repair had been performed with success, most subscapularis repairs can be accomplished with arthroscopic techniques.

Usefulness of the lateral arm free flap for hand defect reconstruction

Purpose: Although various surgical reconstruction methods are available for multidigit defects or soft tissue defects of the hand, they often require a thin flap due to the hand’s unique physical characteristics. We performed a total of 13 cases of lateral arm free flap surgery at our hospital. The purpose of this study was to report the usefulness of this technique. Methods: This study included the following cases: four cases of multiple digit amputations, seven cases of hand dorsum skin defects, one case of first web reconstruction due to web contracture, and one case of an index finger bone and soft tissue defect with only the ulnar-side neuro-vascular bundle remaining. After emergency simple debridement, subsequent reconstruction was performed using a lateral arm free flap. Results: All 13 cases healed without necrosis. Patients who underwent finger amputation were able to preserve the length of their fingers without any additional amputation. Patients who initially had hand dorsum defects were able to maintain grasping function after flap stabilization. The patient with web contracture was able to recover the lost pinching function, and the patient with a combined loss of osteoarticular and soft tissue of the index finger maintained the shape and length of the finger despite the absence of joint function. Conclusion: The lateral arm free flap is a useful reconstruction method that can be easily performed with a single session of regional anesthesia. Since the flap is thin, it is suitable for hand defect reconstruction. If necessary, vascularized bone grafting is possible.

Persistent Chronic Periprosthetic Joint Infection Treated with Three-Stage Revision Hip Arthroplasty: A Case Report

Background: Periprosthetic Joint Infection (PJI) is a dreadful complication of primary Total Hip Arthroplasty (THA). Following revision THA, up to 17% of revision THA can be complicated with PJI. Three-stage revision should only be done if simple debridement fails to treat PJI. Here we present a rare case of persistent PJI, treated with three-stage revision and bone grafting.Case Report: A thirty-seven-year-old female patient came with a chief complaint of hip pain four months ago. Four years ago, the patient had a right column femur fracture and was treated with THA. One year afterward, the implant was infected, and the hip was debrided. One year later, the infection symptom recurred, and three-stage revision hip arthroplasty was planned with one year delay for each stage: removal of the implant, replacement of spacer, and reimplantation. The acetabular bone was augmented using autograft from the iliac wing during reimplantation. After reimplantation, the pain subsides, and the patient can walk normally again.Discussion: Previous studies have found various risk factors that might contribute to the failure of two-stage revision arthroplasty. The infecting bacteria is one of the major risk factors, and therefore appropriate antibiotic is important. Augmentation of bone graft can also supplement acetabular bone loss during failed THA as it helps as a scaffold for bone healing.Conclusion: Three-stage revision hip arthroplasty after PJI using bone graft for augmentation is possible with a good result.

COMBINED ATELOCOLLAGEN INJECTION IN SURGICAL PROCEDURES FOR MEDIAL EPICONDYLITIS OF THE ELBOW

Surgical debridement for medial epicondylitis (ME) is indicated for patients with refractory ME. The clinical efficacy of simple debridement has not been studied sufficiently. Moreover, authors experienced surgical outcome of ME was not as good as lateral epicondylitis. In this regard, authors have combined the atelocollagen injection in the debridement surgery of ME. The purpose of study was to compare clinical outcomes between simple debridement and debridement combined with atelocollagen injection in the ME.Twenty-five patients with refractory ME and underwent surgical debridement were included in the study. Group A (n=13) was treated with isolated debridement surgery, and group B (n=12) was treated with debridement combined with 1.0 mL of type I atelocollagen. Pain and functional improvements were assessed using visual analogue scale, Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (DASH) scale respectively before surgery, at 3, 6 months after surgery and at the final follow-up.Demographic data did not show significant difference between two groups before surgical procedures. Both groups showed improvement in pain and functional score postoperatively. However, at the 3 months after surgery, group B showed significantly better improvement as compared to group A(VAS 3.1 / 2.0, MEPS 71/82 qDASH 29/23). At the 6 months after surgery and final follow-up, both groups did not show any difference.Surgical debridement combined with atelocollagen is effective treatment option in refractory ME and showed better short-term outcomes compared to isolated surgery.

The Efficacy of Simple Debridement Compared to Augmentation with Flexor Hallicus Longus Transfer for Surgical Treatment of Moderate to Severe Insertional Achilles Tendinopathy

Category: Hindfoot; Sports Introduction/ Purpose: Insertional Achilles tendinopathy is a common condition with several treatment modalities encompassing conservative and operative strategies. Surgical treatment often includes debridement and reattachment of the tendon usually with ostectomy of impinging calcaneal bone spurs. Augmentation with a flexor hallicus longus (FHL) tendon transfer is performed to help provide extra strength to the degenerated tendon in more severe cases. Few studies have compared these procedures, and it is currently unclear whether simple debridement is effective for patients with advanced Achilles degeneration. Therefore, the aim of this study is to investigate the efficacy of simple debridement compared to augmentation with FHL transfer for the surgical treatment of moderate to severe insertional Achilles tendinopathy. Methods: This retrospective cohort study included 57 patients who underwent surgical treatment of moderate to severe insertional Achilles tendinopathy as graded on magnetic resonance imaging (MRI) using a classification system described previously. Moderate tendinopathy was defined as tendon thickening greater than 8 mm with less than 50% degeneration while severe was defined by the same degree of thickening but greater than 50% degeneration. Thirty-one patients underwent Achilles tendon debridement and reattachment with or without calcaneal ostectomy and were classified into the “simple debridement” group (mean age: 57.6 years). Twenty-six patients had the same procedures with the addition of a FHL transfer and were classified into the “FHL transfer” group (mean age: 57.9 years). Preoperative, minimum 1-year postoperative, and preoperative to postoperative change in six domains of PROMIS scores were compared within and between groups. Clinical outcomes such as complications, recurrence, and reoperations were also compared. Results: There were no significant differences in demographics between groups. Preoperatively as well as postoperatively, there were no significant differences in PROMIS scores in any domain between groups (Table 1). Both groups demonstrated significant preoperative to postoperative improvements in PROMIS Physical Function, Pain Interference, Pain Intensity, and Global Physical Health (all P&lt; .001). Only the FHL transfer group had significant improvements in Global Mental Health (P = 0.02). Conclusion: Our study found no significant differences in functional and pain-related outcomes between simple debridement and augmentation with FHL transfer for the treatment of moderate to severe insertional Achilles tendinopathy. These results suggest that simple debridement may also be effective in more advanced Achilles tendinopathy and may spare patients the need for FHL augmentation. However, our study is limited by its retrospective design and relatively small sample size. Thus, additional research including prospective long-term follow-up in more advanced tendinopathic stages is required to understand the true differences between the procedures.

The Removal, Excision, Sterilization, and Quarantine (RESQ) Method is a Feasible Alternative Treatment for Cardiac Implantable Electronic Device Infections.

Current guidelines recommend that all infected cardiac implantable electronic devices (CIEDs) should be removed. However, financial or anatomical concerns can lead to management of infection with simple debridement, as opposed to complete removal. In this observational study, we report the outcomes of our modified procedure for this real-world dilemma. The Quarantine (RESQ) method is characterized as follows: the removal (R) of all non-essential foreign materials, including old sutures and leads; the excision (E) of all non-viable, chronically inflamed, granulation, or scar tissue; the sterilization (S) of the remaining generator; and the quarantine (Q) of a new pocket in the sub-muscular layer for reimplantation. From a review of electronic medical records, 30 patients were selected and divided into three groups according to the intervention used: RESQ (n = 9) in group A, simple debridement (n = 16) in group B, and guideline-recommended replacement (n = 5) in group C. Patient baseline characteristics were similar between the groups. After analyzing the proportion of patients that were free from infection one year following their respective interventions, we found that group A performed better than group B (100% and 31.2% infection-free, respectively, p = 0.001), and was comparable to group C (both 100% infection-free, p = not applicable). The RESQ method is a feasible and beneficial alternative for selected patients with CIED infections who are unable to receive a generator replacement according to the recommended guideline.

Honey dressing: a missed way for orthopaedic wound care

PurposeOrthopaedic-related wounds are critical situations calling for care to avoid deep infections and its consequences. The purpose of this study was to evaluate the efficacy of using honey for care of orthopaedic-related wounds with limited resources.Patients and methodsThis prospective study included 50 cases with an average age of 38.18 (range 17–63) years with 38 males and 12 females. The most frequent wound location was the leg (41 patients; 82%), then the foot (six patients; 12%), and the ankle in three patients (6%). The aetiologies were open fractures (34 cases; 68%), infected tibial non-unions (nine cases; 18%), and post-operative infections (seven cases; 14%). Exposed tendon was present in three cases. Bone exposure was present in two cases. Deep infection was present in 29 cases (58%). Besides treating the primary cause, a ribbon of gauze soaked with honey was applied to the wounds after thorough saline washing.ResultsWound sizes were variable. All cases showed improvement in all parameters with complete wound healing and full coverage of bone and tendons. Recurrence of deep infection occurred in three cases and treated by debridement. One case needed sequestrectomy of a small exposed tibial cortical fragment. Exposed tendon cases showed superficial necrosis which was treated by simple debridement. Initial mild itching occurred in five patients with spontaneous resolution.ConclusionWith treating the underlying aetiology and optimising the patient’s general condition, honey was an effective, simple, and affordable method of wound care in different orthopaedic conditions even with exposed bone or tendons.

Long-term results of different surgical options in the management of solitary enchondroma.

We aimed to compare the average 10-year results of patients treated with three different surgical methods, that is, extended curettage, extended curettage with grafting and extended curettage with cementation for the management of solitary enchondromas. Two hundreds and three patients with a solitary enchondroma who underwent surgery at our department between 1990 and 2015 were evaluated retrospectively. Only extended curettage was performed in Group A (n: 75), extended curettage with grafting with autologous bone graft from the iliac crest in Group B (n: 58), and extended curettage with bone cement in Group C (n: 70). Surgical complications and recurrence were analysed and compared between these groups. No significant differences were noted among the groups in terms of gender (P=0.654), age (P=0.264) and follow-up duration (P=0.919). The mean follow-up period in all groups was 122.9 ± 39 (range: 60-271) months. In addition to curettage and cementation, three patients received mechanical support with plate screws because of fracture risk. One patient in the extended curettage with grafting group had surgical site infection that was treated with simple debridement and antibiotherapy. One patient in the extended curettage group had lost motions of the proximal interphalangeal joint, which was treated with aggressive physiotherapy. We compared the average 10-year results of patients treated with three surgical options, namely, extended curettage, extended curettage with grafting, and extended curettage with cementation and no difference was found among the groups in local control of solitary enchondromas.

Comprehensive Arthroscopic Management of Shoulder Arthritis

Glenohumeral arthritis is a challenging problem, especially in the young, active patient. After nonoperative treatment, including activity modification, anti-inflammatory medications, physical therapy, and injections, is exhausted, surgical treatment ranging from simple debridement to arthroplasty is commonly offered. Given concerns regarding arthroplasty implant longevity, there is an interest in joint-preserving procedures. In this difficult population, the authors recommend a systematic, inclusive approach to the array of pathologies encountered in the setting of early glenohumeral arthritis: the Comprehensive Arthroscopic Management (CAM) procedure. CAM consists of the combination of arthroscopy, glenohumeral chondroplasty, synovectomy, loose body removal, microfracture, capsular release, humeral osteoplasty, axillary nerve neurolysis, subacromial decompression, and biceps tenodesis. Key perioperative care includes the use of regional nerve blocks to allow immediate physical therapy with the goal of restoring range of motion by 4 to 6 weeks with strengthening beginning at 6 to 12 weeks and return to full activities at 4 to 6 months. Although this is still considered a bridging procedure, the literature has reported 92% survival at 1 year, 85% survival at 2 years, 77% survival at 5 years, and 63% survival at 10 years. Predictors of failure of the CAM procedure include joint space <2 mm, flattening of the humeral head, and abnormal posterior glenoid morphology. Patient selection and education is therefore essential for optimizing outcomes.

Management of mammalian bites to the external genitalia: a scoping review

To review existing publications to determine the approaches for the medical and operative management of mammalian bites to the external genitalia. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Review guidelines were followed. Four databases were searched. Articles were independently screened and analysed by two reviewers. Publications were included if detailed summaries of genitalia bites and management were documented. Discrepancies were resolved by a third reviewer. Data were extracted from the final article cohort. A total of 42 articles were included in this scoping review with 67 cases of mammalian bites to the genitalia reported in the cohort. The most common injury site was the penis (44.9%). Dog and human bites were the most common type of mammalian bites (61.2% and 26.9%, respectively). In all, 13.4% of cases were managed with medical therapy while 86.6% of cases required surgical intervention. The most common intervention was wound irrigation, debridement, and primary closure (32.8%). Although uncommon, other operative approaches included skin flaps (7.5%) and grafts (4.5%), re-implantation (4.5%), urethroplasty/repair (7.5%), penectomy (3.0%), scrotoplasty (3.0%), and perineal urethrostomy (1.5%). The reported complication rate was 19.4%. The mean follow-up time was 39.9 months. Trauma related to mammalian bites is associated with high utilisation of healthcare resources and cost. Although management of such bites to the genitalia is controversial, surgical intervention is often warranted ranging from simple debridement of devitalised tissue to complex reconstructive surgery. This review underscores the need for further investigation of mammalian bites to the genitalia to improve surgical options and monitor for long-term complication rates.

Limberg Flap Method for Pilonidal Sinus Disease

Sacrococcygeal pilonidal sinus disease is a common chronic inflammation of the natal cleft and is mainly seen in young adults. Authors of some earlier works regarded the condition as congenital. Recently, it has become widely accepted that the condition is acquired, and thought to originate from hair follicles. Many treatment options has described in literature, thus in this study we present our results with Limberg flap reconstruction on pilonidal sinus disease. 38 patients underwent limberg flap reconstruction for pilonidal sinus disease enrolled in this study. No bleeding has occur intra and postoperatively, 2 patients developed urinary retention (%5.2), on 1 patient with diabetes mellitus wound dehiscence has developed which has treated with 3 week long simple debridement method (%2.6). 1 patient developed superficial infection treated with basic antibiotics (%2.6). No other complications has developed. No recurrence has seen in -mean -11.2 month period. We think limberg flap closure on pilonidal sinus disease is an effective and safe option.

Irreparable Massive Rotator Cuff Tear: How do I address

Despite advances in arthroscopic techniques and devices, symptomatic massive contracted rotator cuff tear is still a challenging to most shoulder surgeons. This rotator cuff tissue has all of the f...

Preliminary effect observation on the application of micro-negative pressure in children with small-area deep partial-thickness burn

Objective: To preliminarily observe the effects of application of micro-negative pressure in children with small-area deep partial-thickness burn. Methods: From January 2016 to August 2018, 64 children with small-area deep partial-thickness burn who were admitted to the Department of Burn Surgery of the First Affiliated Hospital of Naval Medical University were recruited in this prospective randomized controlled study. According to the random number table, they were divided into negative pressure group [18 boys and 14 girls, aged (3.9±1.6) years with total burn area of (5.5±2.2)% total body surface area (TBSA)] and conventional group [20 boys and 12 girls, aged (3.8±1.7) years with total burn area of (5.8±1.6)% TBSA], with 32 patients in each group. After admission, simple debridement was performed in the patients of 2 groups. After that, the children in negative pressure group were treated with micro-negative pressure with negative pressure material replaced every 3 to 5 days. Children in conventional group were treated with silver sulfadiazine cream with dressing change every other day. On post injury day (PID) 14 and 21, general wound observation was performed, the wound healing rate was calculated, the exudates from the wounds were cultured and the positive detection rate was calculated. The number of patients requiring surgical skin grafting was recorded and the rate of surgical skin grafting was calculated, and the complete wound healing time was recorded in the patients of 2 groups. Scar formation was evaluated by the Vancouver Scar Scale (VSS) in 3, 6, and 12 months after wound healing. Data were processed with chi-square test, t test, Bonferroni correction, and analysis of variance for repeated measurement. Results: (1) On PID 14, all the necrotic tissue in the wounds of patients in negative pressure group was removed, with few exudates, and most of the wounds had been epithelialized; most of necrotic tissue in the wounds of patients in conventional group was removed, with more exudates and smaller wound healing area than those in negative pressure group. On PID 21, most of the wounds of patients in negative pressure group were healed, and the exudates were rare, while the wound healing area of patients in conventional group was significantly smaller than that in negative pressure group with more exudates. (2) On PID 14 and 21, the wound healing rates [(49.8±3.3)% and (95.8±2.4)%] of patients in negative pressure group were significantly higher than those in conventional group [(40.0±3.2)% and (75.3±2.5)%, t=11.899, 33.461, P<0.01]. (3) On PID 14 and 21, the positive detection rates of wound bacteria of patients in negative pressure group were significantly lower than those in conventional group (χ(2)=6.275, 5.741, P<0.05). (4) The rate of surgical skin grafting of patients in negative pressure group was significantly lower than that in conventional group (χ(2)=5.333, P<0.05). (5) The complete wound healing time of patients in negative pressure group [(23.9±2.3) d] was significantly shorter than that in conventional group [(27.9±1.8) d, t=-7.806, P<0.01]. (6) In 3, 6, and 12 months after wound healing, the VSS scores [(6.9±1.8), (5.6±1.4), (3.4±1.5) points] of patients in negative pressure group were significantly lower than those in conventional group [(9.0±1.5), (7.4±2.0), (5.7±1.6) points, t=-4.987, -4.127, -5.988, P<0.01]. Conclusions: In comparison with routine dressing change, the treatment of application of micro-negative pressure in children with small-area deep partial-thickness burn can significantly improve the wound healing rate and rate of surgical skin grafting, decrease the wound infection rate, shorten the wound healing time, and improve the wound healing quality.

CASE REPORT: SUBCONJUNCTIVAL INJECTION WITH AUTOLOGOUS PLATELET-RICH PLASMA FOR REFRACTORY CORNEAL ULCERS IN A DOG

A 12-year-old, intact, male Golden Retriever dog presented with a 1-month history of corneal ulcer, redness, and occasional squint in the left eye (oculus sinister [OS]). A thorough ophthalmological examination revealed corneal edema, diffuse corneal vascularization, and excessive granulation tissue growth. The tentative diagnosis was chronic superficial keratitis or pannus. After 3 weeks of treatment for OS, blepharospasm and superficial corneal ulceration with a lip of nonadherent epithelium of the right eye (oculus dexter [OD]) developed. No improvement was observed after autologous serum eye drop treatment combined with simple debridement and grid keratotomy on both eyes (oculi uterque [OU]) for 3 months; thereafter, blindness developed. The diagnosis was refractory corneal ulcers. The application of autologous platelet-rich plasma (PRP) was instilled via subconjunctival injection OU every 2 weeks for 2 months. The OU corneas started to re-epithelialize and heal, and the granulation tissues significantly decreased while the vision improved. Therefore, PRP was continued to be administered every 1–2 months for 6 months. After more than 1 year, the OU corneas have healed without recurrent ulceration and with only mild haze. In conclusion, autologous PRP subconjunctival injection is a potentially beneficial addition to the medical management of refractory corneal ulcers in dogs.

Arthroscopic Debridement and Biceps Tenotomy/Tenodesis for the Management of Massive Rotator Cuff Tears

Massive rotator cuff tears present a difficult problem for orthopaedic surgeons to treat and can severely influence quality of life. Unlike small full thickness rotator cuff tears, massive tears are more unpredictable when fixation is attempted and various factors influence outcomes including poor tissue quality, muscle atrophy, fatty infiltration and tendon retraction. The biceps tendon is a known pain generator in patients with rotator cuff pathology. Many patients with large rotator cuff tears can gain excellent function. Prolonged immobilization and physical therapy following attempted repair can lead to additional hardship and pain. A simple arthroscopic debridement and biceps procedure in some cases can improve pain and lead to a quicker recovery. In this article, we describe our preferred surgical technique for arthroscopic debridement and biceps tenotomy or tenodesis when clinically indicated.

Clinical Characteristics and Treatment Outcomes of Patients with Sternoclavicular Septic Arthritis Caused by Staphylococcus aureus

Background Aggressive surgical therapy such as en-bloc resection of the joint is favored in the treatment of sternoclavicular (SC) septic arthritis. However, this practice is based on expert opinion and small case series. We analyzed the clinical characteristics and treatment outcomes of patients with S. aureus SC septic arthritis treated with medical therapy alone or with limited surgical therapy.Methods All adult patients with SC septic arthritis caused by S. aureus at the Asan Medical Center between September 2009 and December 2016 were retrospectively reviewed. Demographic characteristics, laboratory results, underlying diseases/conditions, patient management, and treatment outcomes were assessed. SC septic arthritis due to S. aureus was defined if patients had positive cultures of specimens from the SC joint, or if blood cultures yielded S. aureus, together with physical findings and imaging studies supporting the diagnosis of SC septic arthritis. Limited surgical therapy was defined as simple incision, drainage, and debridement of infected SC joint.ResultsIn total, 22 cases of S. aureus SC septic arthritis were enrolled. Of these 22 patients, 11 received medical therapy alone, 11 underwent limited surgical therapy, and none underwent aggressive surgery. Most patients (73%) had underlying predisposing conditions such as infection at a distant site, diabetes, and liver cirrhosis, and none had IV drug abuse or HIV infection. Complications such as chest wall and/or neck abscess, clavicular and/or sternal osteomyelitis were identified in 18 patients (82%). Patients with chest wall and/or neck abscess had a tendency to be treated with limited surgery than patients without them (73% vs. 27%, P = 0.09). The median duration of intravenous antibiotics in all patients was 35 days (IQR 25–46 days). After a median follow-up of 31 months (IQR 2–40 months), there was no relapse of SC septic arthritis or deterioration of joint function.Conclusion Medical therapy alone or with limited surgical therapy appears to be a successful therapeutic strategy for the complicated S. aureus SC septic arthritis in a selected patient.Disclosures All authors: No reported disclosures.

Effects of arthroscopic patelloplasty combined with lateral patellar retinaculum release and circumpatellar denervation in treatment of moderate and severe patellofemoral osteoarthritis

Objective To investigate the clinical effects of arthroscopic patelloplasty combined with lateral patellar retinaculum release and circumpatellar denervation for treatment of moderate and severe patellofemoral osteoarthritis. Methods A retrospective case-control study was done on 80 patients with moderate to severe patellofemoral osteoarthritis who were treated in our hospital between March 2013 and March 2015. According to treatment methods, the patients were divided into two groups: Group A including 40 cases (22 cases of Outerbridge grade Ⅲ degree and 18 cases of Outerbridge grade Ⅳ) undergone arthroscopic debridement, and Group B including 40 cases (22 cases of Outerbridge grade Ⅲ degree and 18 cases of Outerbridge grade Ⅳ) undergone arthroscopic patelloplasty combined with lateral patellar retinaculum release and circumpatellar denervation. The Kujula scores and Lysholm scores of the patellofemoral joint were compared between the two groups before and after operation. The lateral patellofemoral angle was measured according to patellar axial X-ray performed 3 months after operation to evaluate patellofemoral joint function. Results All patients were followed up for 13-36 months (average 19.8 months). The patellofemoral joint scores of the two groups was increased at different degrees after operation. In moderate patellofemoral osteoarthritis patients, at 3 months after operation and the last follow-up of Group B, Kujula scores [(85.1±6.8)points, (86.8±4.6)points] and Lysholm scores [(88.1±1.8)points, (88.4±2.3)points] were higher than that of Group A [(78.1±5.7)points, (78.3±5.3)points, (82.4±2.9)points, and (82.5±2.5)points] (P 0.05). According to the Lysholm scores, the excellent rate after operation in Group B (86%) was higher than that of Group A (55%) (P 0.05). Within each group, although the Kujula scores and Lysholm scores at 3 months postoperatively and at the last follow-up were improved compared with before operation, but the difference was not statistically significant (P>0.05). According to the Lysholm scores, although the excellent rate after operation of Group B (33%) was higher than that of Group A (28%), with insignificant statistical difference (P>0.05). No matter Outerbridge Ⅲ or Ⅳ patellofemoral osteoarthritis a patient was, the lateral patellofemoral angle of Group A after operation had no significant improvement (P>0.05), while Group B showed significant improvement after operation (P<0.01). Group B had better improvements than that of Group A (P<0.01). Conclusions Compared with simple arthroscopic debridement, patelloplasty combined with lateral patellar retinaculum release and circumpatellar denervation can better relieve the symptoms of moderate patellofemoral osteoarthritis and improve knee function. But for patients with severe patellofemoral osteoarthritis, this method is not effective. Key words: Arthritis; Patellofemoral pain syndrome; Arthroscopies