Therapeutic Arthroscopy Research Articles

Intraoperative cartilage analysis of the first carpometacarpal joint - comparison with conventional staging according to Eaton and Littler.

Osteoarthritis of the first carpometacarpal joint is a common pathology of the hand, which may show an increasing prevalence in Germany due to the demographic development. In recent years, not only the current gold standard - the resection arthroplasty of the thumb saddle joint - has been used, but also therapeutic thumb saddle joint arthroscopy. In addition to the patient's clinical complaints, radiographic diagnostics have been used to decide on treatment, although it has not been proven whether there is a correlation between imaging and clinical complaints. Between 2020 and 2022, 20 articular surfaces of the thumb saddle joint undergoing resection arthroplasty for symptomatic basal thumb osteoarthritis were prospectively examined, mapped and compared with preoperative conventional radiographs. The evaluation of the corresponding articular surfaces showed a higher cartilage destruction at the articular surfaces of the trapezium compared to the first metacarpal. No correlation was found between the stage of osteoarthritis and the Eaton-Littler classification. Overall, there is a patient-specific heterogeneity of the cartilage damage of the articular surface of the trapezium bone, as well in the metacarpal bone I base in relation to the radiographic diagnosis. Furthermore, an inhomogeneity of the radiographic stage of osteoarthritis of the carpometacarpal joint according to Eaton and Littler in relation to the intraoperatively assessed cartilage damage. The statistical significance of the surgically assessed cartilage damage in relation to the conventional radiographs could not be demonstrated. Thus, the treatment of symptomatic osteoarthritis of the carpometacarpal joint should primarily address the patient's individual complaints. The radiographic classification according to Eaton and Littler can be used as an additional factor to decide on the surgical procedure but should not delay the therapeutic treatment. III.

Evaluation of Diagnostic and Therapeutic Arthroscopy of the Knee Joints

Evaluation of Diagnostic and Therapeutic Arthroscopy of the Knee Joints

Frequency of pulley lesions in patients with frozen shoulder

Background. Analyzing the results of studies conduc­ted at various MRI centers in different cities of our country, demonstrates that the diagnosis of pulley lesion was only established in a few of them, while the diagnosis of adhesive capsulitis was established in every third examination. This fact leads to the disregard of the primary cause of the disease, diagnostic errors, and consequently, treatment mistakes. The purpose was to investigate the frequency of different types of pulley lesions involving the ligaments that maintain the integrity of the long head of the biceps (pulley lesion injuries) in patients with adhesive capsulitis of the shoulder joint (frozen shoulder). Materials and methods. We performed 310 ope­rations on patients with adhesive capsulitis of the shoulder. The patients’ ages ranged from 30 to 90 years. The average duration from the onset of the disease to surgical intervention was 189 ± 104 days. All patients were examined clinically and radiologically and all patients underwent MRI study of anatomical structures and shoulder joint arthroscopy. Results. Pulley lesion injuries of the shoulder joint were detected in 84 (27.1 %) of the patients who underwent surgery for a frozen shoulder. This allows us to assert that in this particular patient group, secondary adhesive capsulitis with the development of shoulder joint contracture was predominant. The third (16.5 %) and fourth (12.4 %) types of pulley lesion injuries were the most prevalent. These particular types of pulley lesion injuries exhibit the most contracture-inducing properties, with the third type predominating over the fourth type. А change in the type of pulley lesion damage (an increase in the number of damaged structures of the shoulder), the average indicators of the mobility of the shoulder decreased. Conclusions. In 27.1% of patients who were opera­ted on for idiopathic adhesive capsulitis was detected pulley lesion, which gives us to reconsider treatment approaches and expand the indications for diagnostic and therapeutic shoulder arthroscopy in the earlier stages of the disease.

MORPHOLOGICAL COMPARISON OF THE STROMAL-VASCULAR FRACTION OF THE SUBCUTANEOUS FAT CELL AND INFRAPATELLAR FAT PAD

The use of regenerative technologies is widespread in modern medicine. Adipose-derived stem cells (ADSCs) in the stromalvascular fraction (SVF) appear to be most attractive for use in cell therapy. The objective of this study is to identify morphological differences in the stromal-vascular fraction from the subcutaneous tissue and infrapatelar fat pad (IFP). Material and methods. Data analysis of 15 patients was carried out. The average age of the patients was (44.0 ± 3.8) years with a body mass index of (20.1 ± 1.6) kg/m2 . Aspirates of subcutaneous adipose tissue were obtained from the anterior abdominal wall of 8 women without signs of obesity and comorbid metabolic diseases, as well as the resected IFP from 7 patients during therapeutic and diagnostic arthroscopy, also without signs of obesity. We conducted a comparative characterization of the composition of the obtained histological samples. Morphometric measurements of the diameter of adipocytes were performed. Parametric and non-parametric criteria of statistical analysis were applied. Parametric criteria were used to determine the average diameter of adipocytes and the standard deviation. Nonparametric ones were used to test the hypothesis about the normality of the distribution of the studied indicators according to the Shapiro–Wilk test. The results. SVF, which were obtained in our study from subcutaneous adipose tissue and from IFP, differ in composition, namely, the amount of the stromal component, which is visually much more pronounced in the SVF of IFP, the size of adipocytes, which in SVF from subcutaneous adipose tissue of a statistically larger diameter. Conclusions. It was morphologically proven that SVF of IFP is a promising source of adipose mesenchymal stem cells for regenerative medicine, especially for cartilage regeneration.

Arthroscopic classification in comprehensive diagnosis of avascular necrosis of femoral head

The paper proposes and substantiates an arthroscopic classification of pathological processes in the hip joint associated with avascular necrosis of the femoral head (ANFH). In 2018–2022, the authors developed and advanced to the clinic “Method of minimally invasive two-stage decompression with bone alloplasty” (RF patent No. 2691543), which involved diagnostic and therapeutic arthroscopy of the hip joint as its first stage. The international ARCO classification (Association Research Circulation Osseous classification) was chosen as the prototype for the invention. The endoscopic view was recorded and compared with the data of radiological research methods (radiography, spiral CT and MRI). The revealed changes are characterized by the absence of pronounced pathological signs at stages 0, I according to ARCO, which testifies to the possibility of arthroscopic intervention only for the purpose of joint cavity drainage. Further development of necrosis is accompanied by the formation of cartilage flaps, cartilage defects, acetabular labrum tears, lysis of the ligament of the femoral head with the subsequent development of arthrosis, and, therefore, requires a combined approach.

To Assess the Utility of MRI in Menisci and Ligamentous Injuries of Knee in Correlation with Arthrosopy

Background: The knee joint is a very common site of injury. Most cases are attributable to trauma, repetitive activities and due to sports. Meniscal injuries are most common among knee injuries. MRI is an accurate, non-invasive imaging modality for evaluating knee injuries and determines patient management, saving them from unnecessary arthroscopy. Our study focuses on the utility of MRI and its various sequences in assessing the most common knee injuries. Methods: A prospective, cross-sectional study was done on 50 patients who were clinically suspected of internal derangement of the knee joint underwent MRI after taking written consent. Out of 50 patients in the study, 35 patients underwent knee arthroscopy after MRI .The findings were recorded on pre-structured proforma and correlation was done with arthroscopic findings. Results: Out of 50 patients who underwent MRI, ACL injury was the most frequent, observed in 35 [70%] patients followed by medial meniscus injury, seen in 20 [40%] patients. The sensitivity and Specificity of MRI with respect to arthroscopy in detection of ACL injury are 100% and 88.88%, respectively; thus, MRI is excellent in detecting ACL injury. Conclusion: The study reveals high sensitivity (95-100%) and high specificity (88-100%) for the meniscus and ligament injuries of the knee joint in comparison to arthroscopy. MRI is an appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients.

A rare case report of tenosynovial chondromatosis of the semimembranosus-medial collateral ligament bursa

BackgroundSynovial chondromatosis is an uncommon metaplastic process of the synovial lining that results in the formation of cartilaginous nodules within joints or their associated bursae or tendon sheaths. Radiologic evidence of mineralized bodies within these structures is typically pathognomonic for this condition. Extraarticular chondromatosis is rarer than intraarticular chondromatosis, and the knee is affected less frequently than the smaller joints of the hands and feet. To our knowledge, no reports describing this condition in the semimembranosus-medial collateral ligament (SM-MCL) bursa have been published.Case presentationWe describe a case of tenosynovial chondromatosis in a 37-year-old woman. The case was atypical for both the location within the SM-MCL bursa and the paucity of radiodense or hypointense changes to support a clinical suspicion of chondroid metaplasia on radiographs and T2-weighted MRI, respectively. Recreational weightlifting and swimming by the patient were impaired by chronic pain, and restricted range of motion of the ipsilateral knee persisted despite extensive skilled physical therapy and injections of both corticosteroids and platelet-rich plasma. Thirteen months after a diagnostic and therapeutic knee arthroscopy, open surgical excision of the SM-MCL bursal body was performed, and knee pain and range of motion improved by the 6-week postoperative reevaluation. Pathologic evaluation of the excised tissue was consistent with tenosynovial chondromatosis.ConclusionsSynovial chondromatosis should be considered in the differential diagnosis for recalcitrant bursitis, even in the absence of classic imaging findings.Level of evidence4.

COMPARATIVE ANALYSIS OF MRI AND ARTHROSCOPIC FINDINGS FOR KNEE ACLAND MENISCAL INJURIES

Background and Aim: Common knee injuries include meniscal or ligamentous tears, which can cause discomfort, instability, and movement restrictions. The knee is evaluated using a variety of imaging techniques, such as radiography, CT scans for fractures, and MRIs for soft tissue damage to the knee joint. Our study's objective was to compare the results of the aforementioned two methods and assess the radiological and arthroscopic ndings of anterior cruciate and meniscal injuries. Find out which of the two is more effective at accurately diagnosing ACL and meniscal injury. Material and Methods: This is a prospective study that was done on at least 200 patients who met the inclusion criteria and were being treated for knee injuries at a Tertiary Care Teaching Hospital in India. Among of them, 200 knee injury patients had an MRI, clinical examination, and arthroscopy. Many statistical tests were used to compare and assess the outcomes. These arthroscopy and MRI data were used to compute the accuracy, sensitivity, and specicity. Results: In our investigation, the sensitivity, positive predictive value, and accuracy of an MRI scan in identifying ACL injury were 91.10%, 93.10%, and 87.5%, respectively. In our investigation, the sensitivity, positive predictive value, and accuracy of MRI scan in diagnosing medial meniscus damage were, respectively, 86.8%, 90.12%, and 87.2%. In our study, lateral meniscus injury was detected by MRI scan with 74.15% sensitivity, 71.25% PPV, and 84% accuracy, respectively. Conclusion: Our research demonstrated good sensitivity, specicity, and accuracy for knee joint ACLand meniscal injuries. Meniscus and ACLdamage can be accurately diagnosed by MRI. For therapeutic arthroscopy, MRI is a suitable screening tool, negating the need for diagnostic arthroscopy in the majority of patients. For the assessment of ligamentous and meniscus injuries, magnetic resonance imaging is a reliable and noninvasive method.

Tactics of Surgical Treatment of Slipped Capital Femoral Epiphysis Associated With Mild Chronic Epiphyseal Displacement

Background. The appearing of data on cam-type FAI in patients with sequelae of slipped capital femoral epiphysis characterized by mild chronic epiphyseal displacement suggests that along with fixation of the proximal femoral epiphysis, modeling of the head-neck transition and restoration of the femoral offsets using arthroscopic techniques should be performed. Meanwhile, it is well known that after epiphyseal fixation, complete remodeling of the epimetaphysis and, consequently, disappearance of the morphological substrate of potential FAI can occur due to the ongoing enchondral and echondral growth. In this regard, the issue of indications for intraarticular interventions in studied patients remains currently open. The aim of the study was to determine the incidence of FAI in the postoperative period in patients with slipped capital femoral epiphysis characterized by mild chronic epiphyseal displacement, and to estimate the requirement of further surgical treatment. Methods. The results of the examination of 32 patients with mild chronic epiphyseal displacement in the typical posterior inferior direction who underwent cannulated epiphyseal screw fixation were analyzed for the severity of epimetaphysis remodeling and the presence of FAI in the postoperative period. Clinical, radiological, magnetic resonance, and statistical methods were used. Results. At the age of 18-19 years, FAI with pain syndrome in everyday life was found in 9 (28.1%) patients 8 of them did not have even partial remodeling of the femoral component of the joint, another 9 (28.1%) patients did not suffer from pain syndrome in everyday life, but had other clinical, radiological and MR signs of cam-type FAI. Complete or almost complete remodeling of the proximal femoral epimetaphysis occurred in 14 (43.8%) patients. Conclusion. In our opinion, therapeutic and diagnostic arthroscopy of the hip joint for the purpose of modeling the head-neck transition at the age of 18-19 years is indicated for more than one quarter (28.1%) of the investigated patients because of the presence of reliable signs of FAI.

Rationale for minimally invasive surgery and its clinical use in early ANFH

Objectives. A study of the expedience of arthroscopic revision of hip cavity in conjunction with tunnelling, revision and sanitation of the femoral head necrosis site, followed by bone alloplasty early in disease, during surgical treatment of ANFH patients.Materials and methods. Minimally invasive two-stage decompression with bone alloplasty was performed as a surgical treatment in stage 0, 1, 2 ANFH patients at the orthopaedic unit of Vladimirtsev Territorial Clinical Hospital of Khabarovsk during 2017–2021. The survey included 60 patients examined as follows: clinical examination, radiography, multislice computed tomography and magnetic resonance imaging, with follow-ups in 6 and 12 months.Results and discussion. A detailed arthroscopy analysis was performed at different stages of the disease sequence, which allowed a comprehensive comparison of X-ray and intraarticular change data.Conclusions. The study demonstrated that therapeutic and diagnostic hip arthroscopy offers a number of clear advantages and allows decision on a surgical treatment tactics that minimises postoperative complications. The use of minimally invasive surgeries in early ANFH allows a stable regain of the patient social activity to postpone radical surgical interventions.

Wrist Arthroscopy Is Effective for the Diagnosis and Treatment of Chronic Wrist Pain in Pediatric Patients

PurposeTo determine the outcomes of diagnostic and therapeutic arthroscopy in patients with chronic wrist pain who are younger than 16 years of age.MethodsWe retrospectively analyzed collected data from medical records of patients who had undergone wrist arthroscopy by the senior author between 2015 and 2017 for longstanding wrist pain and were 16 years old or younger. Findings from preoperative magnetic resonance imaging (MRI) were compared with the intraoperative diagnosis, and midterm results were gathered by a telephone interview.ResultsTen patients were included. Eight of 10 patients had undergone conservative therapy before surgery, and 60% had a history of single trauma. In 6 of 10 patients, the arthroscopic diagnosis correlated with the MRI findings. Eight of 10 wrists (80%) showed a tear of the triangular fibrocartilage complex (TFCC). Only 4 of the 8 TFCC tears were correctly identified by 3-Tesla MRI.ConclusionsIn our study, wrist arthroscopy was an effective tool not only to diagnose but also to treat relevant TFCC lesions both in adolescents and children suffering from persistent wrist pain. A 3-Tesla MRI was neither sensitive nor specific enough to correctly diagnose lesions in small pediatric wrists.Level of EvidenceIV, Therapeutic case series.

Therapeutic and diagnostic arthroscopy of the hip joint (first experience)

The experience in therapeutic diagnostic hip arthroscopy is presented. Hip arthroscopy was performed in 11 patients, aged 3-11 years. There were 5 patients with congenital hip joint dislocation, 3 patients with Legg-Kalve-Perthes disease, 2 patients with deforming coxarthrosis and 1 patient with pathologic hip dislocation. The original technique for hip arthroscopy is suggested. High efficacy of arthroscopy for the diagnosis and treatment of intraarticular hip pathology is shown.

Causes of knee pain evaluated by arthroscopy after knee arthroplasty: a case series.

The origin of persistent pain and joint limitation after knee arthroplasty are controversial and difficult to diagnose. Knee arthroscopy is indicated when the results of routine evaluation tests are not clear. The purpose of this study was to determine through arthroscopy the cause of post-knee-arthroplasty pain symptoms in patients without a prior diagnosis of cause of pain. This prospective case series study described the outcomes of 34 patients (35 knees) with pain and limited function in the arthroplastic joint, who underwent diagnostic and therapeutic arthroscopy. Patients were clinically evaluated using range-of-motion tests and the Lysholm, Hospital for Special Surgery (HSS) and Knee Society Score (KSS) scales. The procedure found cyclops in 17 knees, synovitis in 9 knees, arthrofibrosis in 6 knees, polyethylene wear with debris in two knees, and polyethylene bouncing in one knee with unicompartmental arthroplasty with a mobile polyethylene platform. It was effective for the relief of pain symptoms, with excellent or good outcomes in 80% of cases; there was a poor outcome in 11.43%, which maintained the presentation of pain and underwent revision arthroplasty, and, in 8.57%, did not undergo another surgery despite symptom persistence. Post-arthroplasty knee arthroscopy seems beneficial in patients with pain and without a pre-established diagnosis and who had already undergone conservative treatment unsuccessfully.

Генезис структурно-функціональних порушень та гідростатична модель кісти Бейкера

Вступ. Колінний суглоб оточують різноманітні кістоподібні утворення (КПУ) — бурси, які у нормі клінічно не проявляються. Усі синовіальні порожнини, до яких, зокрема, належать колінний суглоб та бурси, які оточують колінний суглоб, містять синовіальну рідину. Синовіальна рідина є ультрафільтратом плазми крові і складається із білків та інтерстиціальної рідини. У літературі описані бурси, що оточують колінний суглоб, висвітлена ультразвукова класифікація кіст Бейкера залежно від стадії перебігу, яка запропонована І.М. Даниловою [10], та класифікація кістозного переродження меніска, але відсутня інформація щодо патофізіологічних та гістохімічних змін, які відбуваються у КПУ ділянки колінного суглоба, а також відсутня патофізіологічна модель КПУ ділянки колінного суглоба, яка б відображала природу даного захворювання з точки зору фізико-біохімічних процесів. Матеріали та методи. У травматологічному відділенні клініки ­ушкоджень Військово-медичного клінічного центру Північного регіону з початку 2016 року під спостереженням знаходилось 15 пацієнтів із клінічної картиною кістоподібного утворення ділянки колінного суглоба, що підтверджено інструментальними методами обстеженнями: ультразвуковим дослідженням (УЗД), магнітно-резонансною томографією (МРТ) та спіральною комп’ютерною артрографією (СКТА) колінного суглоба. Із них литково-напівперетинчастий бурсит спостерігався у 9 пацієнтів, кісти менісків — у 5 пацієнтів, бурсит переднього відділу колінного суглоба — в 1 пацієнта. Серед пацієнтів 11 чоловіків та 4 жінки. Середній вік пацієнтів становив 43,5 року. Об’єктом дослідження були кістоподібні утворення ділянки колінного суглоба. Усім хворим із КПУ проводили комплексне інструментальне обстеження, яке включало УЗД, СКТА, МРТ, вимірювання внутрішньосуглобового та внутрішньокістозного тисків за допомогою контактного манометра фірми Stryker та надалі — діагностично-лікувальної артроскопії. На основі отриманих даних УЗД проводився розподіл хворих на 4 групи, що базується на процентному відношенню внутрішньопросвітних нашарувань (включень) до загального просвіту КПУ, що дало можливість сформувати нову класифікацію КПУ ділянки колінного суглоба для вибору того чи іншого методу лікування. Результати та обговорення. Для формування та прогресування КПУ має значення підвищений тиск, який становить у середньому 29 мм рт.ст. у положенні згинання та до 58,4 мм рт.ст. у положенні розгинання. Виходячи із попередніх даних, на нашу думку, критичним показником тиску, при якому може настати розрив кісти Бейкера, є тиск більше 60 мм рт.ст. Зазвичай таке ускладнення виникає при тривалому існуванні кісти, коли тривала адсорбція білкових молекул на стінці кісти призводить до адсорбційного зниження міцності та зниження поверхневого натягу — ефект Ребіндера. Висновки. Враховуючи дані біохімічних процесів, УЗД та ендоскопії кіст Бейкера на різних стадіях, ми дослідили, що сама стінка кісти не потовщується, а відбувається пристінкове нашарування білкових молекул із формуванням глобул, які і формують так звану псевдостінку. У подальшому ці нашарування починають формувати перетинки між протилежними стінки, ущільнюватись, що призводить до камерності КПУ. На пізніх стадіях дані нашарування переважають над просвітом КПУ. Запропонована нами класифікація заснована на визначенні процентного відношення внутрішньопросвітних нашарувань до загального просвіту КПУ у двох зрізах та відображає основні морфологічні зміни, що дає можливість визначити оптимальний метод лікування даного кістоподібного утворення та широкого практичного використання у травматології та ортопедії.

Оценка эффективности артроскопии тазобедренного сустава в оперативном лечении АНГБК у взрослых

During 2017–2021 in the facilities of the orthopedic department of the Khabarovsk Krai Clinical Hospital named after prof. O.V. Vladimirtseva patients with avascular necrosis of the femoral head (ANFH) stages 0, 1 and 2 have been surgically treated with minimally invasive two-stage decompression with bone alloplasty. The results of radiological diagnosis and arthroscopic picture in the initial stages of the disease were evaluated. The results obtained, the identity of the MRI diagnostic data and the arthroscopic featers indicate the unreasonableness of performing therapeutic and diagnostic arthroscopy in combination with tunnelization, revision of the femoral head cyst and further alloplasty in stages 1 and 2 of the disease, which does not exclude the possibility of using this technology in other stages of ANFH

Device-Based Enrichment of Knee Joint Synovial Cells to Drive MSC Chondrogenesis Without Prior Culture Expansion In Vitro: A Step Closer to 1-Stage Orthopaedic Procedures

Background: Synovial fluid (SF) mesenchymal stem cells (MSCs) are derived from the synovial membrane and have cartilage repair potential. Their current use in clinical practice is largely exploratory. As their numbers tend to be small, therapeutic procedures using MSCs typically require culture expansion. Previous reports indicate that the stem cell–mobilizing device (STEM device) intraoperatively increases SF-MSCs. Purpose: This study evaluated the chondrogenic potential of non–culture expanded synovium-mobilized MSCs and SF-microfragments obtained after enrichment using the STEM device and ascertained if device-mediated synovial membrane manipulation facilitated ongoing MSC release. Study Design: Controlled laboratory study. Methods: Two samples of aspiration fluid were collected intraoperatively before and after STEM device utilization from patients (n = 16) undergoing diagnostic or therapeutic knee arthroscopy. Human knee synovium (n = 5) was collected during total knee replacement, and a suspended culture was performed to assess the effect of the STEM device on ongoing MSC release. Colony forming unit–fibroblastic assays were used to determine the number of MSCs. Additionally, cytometric characterization of stromal and immune cells and chondrogenesis differentiation assay were performed without culture expansion. Filtered platelet concentrates were prepared using the HemaTrate system. Results: After STEM device use, a significant increase was evident in SF-MSCs (P = .03) and synovial fluid–resident synovial tissue microfragments (P = .03). In vitro–suspended synovium released significantly more MSCs following STEM device use than nonstimulated synovium (P = .01). The STEM device–released total cellular fraction produced greater in vitro chondrogenesis with significantly more glycosaminoglycans (GAGs; P < .0001) when compared with non–STEM device synovial fluid material. Nonexpanded SF-MSCs and SF-microfragments combined with autologous filtered platelet concentrate produced significantly more GAGs than the complete chondrogenic media (P < .0001). The STEM device–mobilized cells contained more M2 macrophage cells and fewer M1 cells. Conclusion: Non–culture expanded SF-MSCs and SF-microfragments had the potential to undergo chondrogenesis without culture expansion, which can be augmented using the STEM device with increased MSC release from manipulated synovium for several days. Although preliminary, these findings offer proof of concept toward manipulation of the knee joint environment to facilitate endogenous repair responses. Clinical Relevance: Although numbers were small, this study highlights 3 factors relevant to 1-stage joint repair using the STEM device: increased SF-MSCs and SF-microfragments and prolonged synovial release of MSCs. Joint repair strategies involving endogenous MSCs for cartilage repair without the need for culture expansion in a 1-stage procedure may be possible.

Arthroscopic Anatomy of the TFCC with Relevance to Function and Pathology.

Introduction The authors present a new comprehensive arthroscopic anatomical description of the fibrocartilage complex "TFCC" which is related to the current TFCC functional and pathological knowledge. Methods Our description of the TFCC is based on an arthroscopic view from the 3-4 portal as observed in more than 100 wrist arthroscopies in fresh cadavers and more than 1000 diagnostic and/or therapeutic wrist arthroscopies. Results TFCC is considered as a 3-D-3-part box-like structure (Reins, Wall and Disc). The first TFCC component ("R") corresponds to 2 strong radio-ulnar ligamentous Reins, one dorsal (DRUL) and one palmar (PRUL). This "V-shaped" RUL reins diverge from the fovea and ulnar styloid to the volar and dorsal edges of the sigmoid notch. It is a main stabilizer of the DRUJ. The second TFCC component ("W") is a continuous, radially concave Peripheral Capsular Wall attached and perpendicular to the RUL reins. It surrounds the ulnar aspect of the ulno-carpal interval while attaching to the RUL reins proximally and to the medial carpus distally. Along with the radiocarpal ligaments, the TFCC peripheral capsular wall contributes to the stability of the carpus with respect to the radius-ulna entity. This is especially true for the thick volar TFCC capsular wall. The third TFCC component ("D") is the disc proper which is a static and dynamic shock absorber intercalated between the ulnar head and the medial proximal row in the coronal/sagittal planes and between the two strands of the RUL in the axial plane. Its pathology is influenced and related to the ulnar variance. Discussion This new arthroscopic description of the TFCC provides a comprehensive anatomical, functional ant pathological background for TFCC disorders analysis and treatment. Currently known disorders are included as "R 1,2,3,4", "W 1, 2, 3, 4", and "D 1, 2". Combined TFCC disorders and further new pathology descriptions may be included in this open classification.

The Validation of Clinical Examination and MRI as a Diagnostic Tool for Cruciate Ligaments and Meniscus Injuries of the Knee Against Diagnostic Arthroscopy.

Background: This study was conducted to compare the accuracy of MRI findings and clinical examination of ligamentous and meniscal injuries of the knee, taking arthroscopy as a standard diagnostic tool in knee injuries. Methods: All patients with knee injuries attending the outpatient department or emergency of our hospital underwent clinical examination. Out of them, 60 patients with knee injuries were subjected to clinical examination, MRI, and then arthroscopy. The findings of these diagnostic tools in respect to the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and meniscus injuries were validated, compared, and analyzed using various statistical tools. The accuracy, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and specificity were calculated and an agreement between various tests was established using kappa statistics.Results: The accuracy of clinical examination in our study was 88% for ACL tears, 85% for meniscal tears, and 100% for PCL tears. The kappa measure of agreement between arthroscopy and clinical finding and MRI for ACL was 0.610 and 0.698, respectively, which was statistically significant. MRI (98.1) was found to be a more sensitive test for detecting ACL injury than clinical examination (90.4%) resulting in higher diagnostic accuracy (98.3%), while diagnostic accuracy of clinical examination and MRI was found to be 100% for PCL injuries. Hence, MRI is an excellent screening tool for ligamentous and meniscal injuries of the knee joint. We can avoid diagnostic arthroscopy in patients with knee injuries having equivocal clinical and MRI examinations and can proceed for therapeutic arthroscopy to deal with such injuries. Conclusions: For the assessment of ligamentous and meniscal injuries, MRI is an accurate and noninvasive modality. It can be used as a first-line investigation but arthroscopy remains the gold standard.

Arthroscopic Pisiform Excision in Pisotriquetral Osteoarthritis Technique Using a Direct Pisotriquetral Portal.

Pisotriquetral (PT) joint arthritis is a common cause of ulnar-sided wrist pain. Open pisiform excision is a well-established procedure and is indicated when the conservative treatment fails. Although arthroscopic visualization of the PT joint is part of the routine examination in a patient with ulnar-sided wrist pain, therapeutic arthroscopy of the PT joint is limited to one case in the literature through the standard dorsal portals. Arthroscopic pisiform excision is a novel technique described by the authors. The first aim of this procedure is pain relief maintaining wrist stability and strength. With this minimally invasive approach we believe that preserving the flexor carpi ulnaris and the PT ligament complex we maintain their biomechanical function, while at the same time, reducing scar tenderness and postoperative discomfort with better esthetic results and less recovery time. In addition to standard dorsal portals, a direct PT portal was used to have access to the PT space and as a working portal to complete the pisiform excision.

Study of correlation between MRI and arthroscopic findings in anterior cruciate ligament and meniscal injuries of the knee joint

Introduction: Meniscal or ligamentous injuries of knee joint are common and result in pain, instability and restriction of movement. MRI is used as a screening tool to diagnose or support clinical diagnosis for these injuries prior to offering patients with arthroscopic treatment. However, the sensitivity of MRI for the detection of meniscal injury is not 100%. Arthroscopy of knee joint can be used for both diagnostic and therapeutic purposes. It is regarded as the gold standard among the investigative modalities. Aim of our study was to correlate radiological and arthroscopic findings of meniscal injuries of knee. Materials and Methods: Cross-sectional study of 20 patients with history of suspected internal derangement of knee, evaluated with MRI (1.5 T) and correlated with arthroscopy in Mamata Academy of Medical Sciences from May 2019 to November 2020. Results: The Sensitivity, PPV, Accuracy of MRI scan in detecting ACL injury in our study were 95%, 100% & 95% respectively. Whereas Sensitivity, specificity, PPV, NPV, Accuracy of MRI scan in detecting medial meniscal injury in our study were 77.7%, 81.8%, 81.8%,77.7 & 80.0% respectively. Most common lesions found were ACL and Medial Meniscal tears.Summary and Conclusion: MRI is a useful non-invasive modality in diagnosing cruciate ligament and meniscal injuries. MRI should be considered as the first line of investigation in all patients with suspected internal derangements of knee. MRI is useful as a pre-operative screening modality, improves the quality of diagnostic and therapeutic arthroscopies and further reduces the morbidity. Arthroscopy is the standard diagnosing tool in all patients with suspected internal derangements of knee should be performed for cases where intervention is required.