Symptomatic Loose Body Research Articles

Symptomatic loose body in pisotriquetral joint as a cause of ulnar-sided wrist pain

Symptomatic loose body in pisotriquetral joint as a cause of ulnar-sided wrist pain

Giant loose body of knee joint in a case of osteoarthritis knee: A case report and review of literature

Loose bodies are free floating fibrous, bony, cartilaginous or osteo cartilaginous fragments inside a synovial joint. While majority are asymptomatic, some of them are symptomatic and can present with swelling, knee pain, locking of joint as well as restriction of movement. A symptomatic loose body, whatever maybe the size, demands removal. Even though arthroscopy is the most common operative intervention used in removal, arthrotomy is indicated to remove bodies that are present at inaccessible areas or are very large in size.

Osteochondritis Dissecans of the Capitellum :Review of the Literature.

Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent baseball players. Previous studies have not found an association of player position with capitellar OCD. Elbow pain and a longer playing history might be related to progression of capitellar OCD but do not in themselves increase the risk of development of the condition. The cause of capitellar OCD is likely to include a combination of repetitive microtrauma and internal factors, such as ischemia and genetic predisposition. A combination of radiography, computed tomography, magnetic resonance imaging, and ultrasonography have aided our understanding of the pathology of capitellar OCD. Screening using ultrasonography enables early detection and provides an opportunity for successful conservative treatment. Treatment has conventionally included both operative and nonoperative measures based on the stage and size of the lesion, skeletal maturity, subjective symptoms, and structural integrity of the cartilage. Early-stage lesions respond better to nonoperative treatment than those in more advanced stages. Operative indications include persistent symptoms despite nonoperative treatment, symptomatic loose bodies, and displacement or detachment of fragments. J. Med. Invest. 67 : 217-221, August, 2020.

Long Term Results of Arthroscopic Debridement of Osteochondritis Dissecans in Adolescent Athletes

Objectives:Osteochondritis dissecans (OCD) of the capitellum is a well-recognized cause of elbow pain and disability in adolescent athletes.Treatment of the lesions is determined by the age, symptom, radiographic appearance, and whether the cartilage is intact. Surgical indications include persistent symptoms despite conservative treatment, symptomatic loose bodies, and displacement or detachment of the fragment. Both arthroscopic and open treatments have been proposed and most authors recommend initial arthroscopic treatment with conversion to arthrotomy, as needed. Surgical treatment may consist of removal of loose bodies or fragments, fragment fixation with a bone graft, and autologous osteochondral plug grafting. Arthroscopic debridement is a common and minimally invasive procedure, however, little is known about the long term outcome of arthroscopic debridement for adolescent OCD patients. The purpose of this study was to investigate minimum 10 year follow-up outcome of arthroscopic debridement of OCD in adolescent athletes.Methods:We retrospectively evaluated 25 athletes who had arthroscopic debridement. The average age at surgery was 15.0 years (range, 13-17 years).The sport related to the onset of the symptoms was baseball for 23 patients, and basketball and kendo for 1 patient each. We conducted arthroscopy in the supine position, and use 2.9-mm arthroscopes of 30° and 70°. Arthroscopic treatment for OCD may require 2 anterior and 2 posterior portals. Once the loose bodies are removed, all unstable cartilage of the capitellum lesion is removed to create a stable bed. If any sclerotic changes to the lesion bed are observed, we create microfractures in the lesion bed. The mean follow-up was 12.7 years (range, 10-13.5 years). The assessment included elbow pain, Timmerman and Andrews (TA) scores for the subjective component, and return to sports. Preoperative radiographic lesion size was categorized according to the classification of Takahara et al.Results:At final follow-up, 19 patients (76%) had no elbow pain, 5 patients (20%) had occasional mild pain, and only 1 patient (4%) had pain with moderate activity. TA scores for the subjective component was as follows; 100 points in 19patients, 95 points in 3 patients, 90 points in 2 patients, and 55 points in 1 patient. The evaluation result was excellent in 24 patients (96%) and poor in 1 patient (4%). Of all the patients, 22 patients (88%) returned to a competitive level at which they had previously played. Two patients chose another sport, and 1 patient retired from sport activity (Table 1). TA scores were associated with pain and preoperative radiographic osteochondral defects. The prevalence of elbow pain was 0% in small defect, 20% in moderate defect, and 69.2% in large defect.Conclusion:Long term results suggest that arthroscopic debridement of OCD for small osteochondral defects leads to excellent results and allow a return to the previous sport level.Return to sport after arthroscopic debridement for OCDReturn to sportNo. of patients (%)Previous competitive level22 (88%)Another sport2 (8%)Retired1 (4%)

Arthroscopic Capsular Plication and Labral Seal Restoration in Borderline Hip Dysplasia: 2-Year Clinical Outcomes in 55 Cases

To report clinical outcomes in patients with borderline dysplasia undergoing an arthroscopic technique of labral seal restoration with minimal acetabular rim resection and capsular plication. Patients younger than 40years with a lateral center-edge angle of 18° greater and 25° or less and 2-year follow-up after undergoing an arthroscopic technique of labral seal restoration with minimal rim resection (≤2mm) and capsular plication (3-5 sutures placed in an oblique orientation to create an imbrication and inferior shift) were included. Patients underwent arthroscopy for symptoms that had marginal improvement with a minimum 6-week structured physical therapy program. Patients with a Tönnis grade of 1 or greater, a center-edge angle of 17° or less, and Legg-Calvé-Perthes disease were excluded. The following patient-reported outcomes (PROs) were recorded prospectively but retrospectively reviewed: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports-Specific Subscale, and Hip Outcome Score-Activities of Daily Living. The visual analog scale score, patient satisfaction score, complications, and revision procedures were also recorded. A 2-tailed paired t test was used to analyze change in preoperative to postoperative PRO scores. Significance was defined as P < .05. During the study period, 232 hip arthroscopies were performed in patients with a lateral center-edge angle between 18° and 25°. The inclusion criteria were met by 59 procedures. Of these procedures, 55 (93.2%) were available for follow-up. The labrum was repaired, debrided, and reconstructed in 37 procedures, 17 procedures, and 1 procedure, respectively. The iliopsoas was released in 34 procedures, the ligamentum teres was debrided in 29, and femoral osteoplasty was performed in 32. At 2-year follow-up, there was significant improvement in the mean scores of all PROs compared with baseline. Mean improvements for the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports-Specific Subscale, and Non-Arthritic Hip Score were 20.7, 17.5, 27.6, and 20.0, respectively. There was significant improvement in the visual analog scale score at 2years, decreasing by 3.16 compared with baseline, and the mean patient satisfaction score was 8.09, with 83.6% of patients achieving a good to excellent result (patient satisfaction score ≥7). No complications were related to the procedure, and 6 patients (11%) required revision procedures (4 for labral retear, 1 for painful iliopsoas internal snapping, and 1 for removal of a symptomatic loose body). Arthroscopic intervention that encompasses minimal rim resection, restoration of labral function, and capsular plication significantly improves outcomes in patients with borderline dysplasia who do not warrant a periacetabular osteotomy. Level IV, therapeutic case series.

Hip arthroscopy: surgical approach, positioning, and distraction.

The hip is the most deeply recessed joint in the body making it difficult to access arthroscopically. However, for the patient with a symptomatic loose body or labral tear open techniques are less advantageous. It is for this reason that, however difficult, minimally-invasive approaches to the hip have been developed. Meticulous attention to proper positioning and portal placement is paramount for safe and successful arthroscopy of the hip. The current authors will review the seminal features of positioning and minimally-invasive surgical approaches to the hip.

Symptomatic Loose Bodies of the Knee Located in a Popliteal Cyst

Locating loose bodies in a knee arthroscopically can be challenging. Common locations for loose bodies to hide include the lateral and medial gutters as well as under the menisci. In 1986, Fergusson and Burge reported a single case of a loose body intermittently traveling between the intracapsular space and an extracapsular popliteal cyst. This article describes a similar event involving a 22-year-old man. Our patient experienced recurrent symptomatic loose bodies in the knee requiring previous knee arthroscopies. Most recently the patient had a radiographically documented and clinically symptomatic intra-articular knee loose body prior to surgery. Initial basic diagnostic knee arthroscopy did not reveal the loose body. On further arthroscopic evaluation of the posteromedial compartment of the knee, a capsular opening to a popliteal cyst was discovered. An accessory posteromedial portal was then used to directly visualize the contents of the cyst. Three loose bodies capable of traveling between the cyst and the joint were discovered. Transillumination allowed for safe localization of the cyst and subsequent percutaneous removal of the loose bodies under direct arthroscopic visualization.We recommend direct arthroscopic visualization of the posteromedial and posterolateral compartments of the knee when a known loose body cannot be located during basic diagnostic knee arthroscopy.

Loose body in the wrist: diagnosis and treatment

Purpose: The purpose of this study was to report on 10 cases of symptomatic loose bodies in the wrist joints diagnosed using arthroscopy. Type of Study: Retrospective review. Methods: From1986 to 2000, we performed wrist arthroscopy for 707 patients, 10 of whom had loose bodies in the wrist joints. The clinical records were reviewed retrospectively. The patients included 8 men and 2 women, and the average age was 28 years (range, 16 to 67 years). The chief complaint was wrist pain in all patients, but locking was uncommon. Preoperative diagnosis was difficult in all but 3 cases; in those cases, an osseous component was found within the loose bodies. The remaining cases were diagnosed by wrist arthroscopy. Results: The loose bodies existed in the radiocarpal joint in 5 cases, and all could be removed arthroscopically. In the other 5 cases, the loose bodies were in the distal radioulnar joint, and arthrotomy was needed to remove them. After removal of the loose bodies, the pain was relieved in all cases without any surgical complications. Conclusions: Loose bodies in the wrist joint should be included in the differential diagnosis for chronic wrist pain. Wrist arthroscopy is of value because the preoperative diagnosis is usually difficult.

Hip arthroscopy in the lateral position

The hip joint is the most deeply recessed joint in the body, making it difficult to access arthroscopically. Thelateral position facilitates peritrochanteric approaches, which provide reproducible bony landmarks for orientation, as well as access for most pathology within the hip joint. Minimally invasive approaches to the hip joint have been developed for situations where open techniques are less advantageous, such as the patient with a symptomatic loose body or labral tear. The different portals have varying abilities to visualize different anatomic structures. Knowledge of anatomic relationships is of utmost importance in the use of the various portals. Meticulous attention to proper positioning, adequate joint distraction, and portal placement is paramount for safe and successful arthroscopy of the hip. This article will review the seminal features of lateral positioning and minimally invasive surgical approaches to the hip.

Gore-Tex prosthetic ligament in anterior cruciate deficient knees.

Reconstruction for symptomatic anterior cruciate deficient knees has yielded varying success rates. Prosthetic cruciate replacement has recently become a potentially attractive alternative. The results of the Gore-Tex polytetrafluoroethylene ligament, which is intended as a permanent replacement, are reported. Eighty-two patients were followed prospectively, mean age was 28 years (range, 16 to 51 years) and mean followup was 18 months (range, 12 to 30 months). Subjective scores improved in all categories, including pain, swelling, giving way, locking, and stair climbing. All patients without complications had no episodes of actual giving way, considered themselves improved, and returned to activities of daily living at 3 weeks and athletics at 8 months. Range of motion lacking at 3 months was 2 degrees of extension and 10 degrees of flexion, and at 12 months was 0 degrees of extension and 4 degrees of flexion. All mean objective data, including the anterior drawer, Lachman, and pivot shift, demonstrated improvement at final followup. Cybex testing revealed improvement in relative quadriceps strength from 88% to 99%. The KT-1000 Arthrometer showed improvement in the injured-normal knee difference score throughout the follow-up period. Of importance is that while final objective data was improved over initial data, an early nonprogressive shift toward loosening was indicated by worsening of the drawer, Lachman, pivot shift, and KT-1000 scores. This shift may be attributed to resorption of interposed soft tissue, creep, or loosening of the graft. Subjective scores remained stable after improving. Complications included four ruptures, four chronic sterile effusions with partial attenuation, one infection, and one symptomatic loose body.(ABSTRACT TRUNCATED AT 250 WORDS)